Black pediatric patients more likely to be restrained in EDs than white peers, study finds

Black pediatric patients are more likely to be physically restrained in EDs than their white peers, according to a study by researchers at Yale.

In a research letter published online in JAMA Pediatrics, Katherine A. Nash, MD, a member of the National Clinician Scholars Program at the Yale University School of Medicine, and colleagues described a cross-sectional study of 551,740 pediatric visits to 11 different EDs within an unidentified New England health care system between 2013 and 2020, including 532 (0.1%) that had an associated physical restraint order.

“Racial and ethnic disparities in restraint use likely reflect racism at multiple levels within and beyond the emergency care continuum (community, emergency medical services, and ED),” Nash and colleagues wrote. “Potential drivers include interpersonal racism in the perception of threat or aggression, institutional racism leading to disparities in access to behavioral health care, and structural racism leading to disproportionate experiences with risk factors for mental illness, including poverty, trauma, and discrimination.”

Among the patients involved in a physical restraint order in the 11 EDs, 39.1% were Black, 37.6% were white and 19.4% were Hispanic. Most — 81.2% — were aged 10 to 16 years, 66.2% were male, and 71.2% were publicly insured.

Around 80% of visits involving a physical restraint order included a child presenting with a behavioral health problem, 73.9% involved patients with outpatient psychotropic medications, and 43.8% had a behavioral health diagnosis, the researchers reported.

Nash and colleagues found that Black patients were almost twice as likely to be physically restrained compared with white patients (adjusted OR = 1.8; 95% CI, 1.4-2.32). They found no difference in restraint use between visits for Hispanic and white patients.

“Documenting racial and ethnic inequities is important but insufficient,” the researchers concluded. “Physical restraint is a traumatic experience that can have lasting consequences for a child’s development and well-being. Further research should identify interventions that address inequities in physical restraint use and ensure a health care system that is a therapeutic rather than traumatic environment.”

References:

Nash, K et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.3348