Pharmacologic restraint used in 3 percent of pediatric mental health admissions

The use of pharmacologic restraints occurs in 3 percent of hospitalizations for children admitted with a primary mental health diagnosis, according to a study published online Dec. 11 in Pediatrics.

Benjamin Masserano, M.D., from the University of Texas Southwestern in Dallas, and colleagues conducted a retrospective, cross-sectional study using the Pediatric Health Information System database, including children aged 5 to 17 years with a primary mental health diagnosis between 2016 and 2021. The rates of pharmacologic restraint use per 1,000 patient days in medical inpatient units were examined for 13 mental health diagnoses.

The researchers found that 3 percent of admissions and 1.3 percent of patient days of the 91,898 hospitalizations across 43 hospitals involved pharmacologic restraint. The incidence of pharmacologic restraint use increased by 141 percent, while trends in the rate of use remained stable. Diagnoses with the highest rates of pharmacologic restraint days included autism, substance-related disorders, and disruptive disorders (79.4, 45.0, and 44.8 per 1,000 patient-days, respectively).

A significant increase in restraint rate was seen in disruptive disorders, bipolar disorders, eating disorders, and somatic disorders (rate ratios [95 percent confidence intervals], 1.4 [1.1 to 1.6], 2.0 [1.4 to 3.0], 2.4 [1.5 to 3.9], and 4.2 [1.9 to 9.1], respectively). Significant decreases in the rate were seen for autism and anxiety disorders (rate ratios [95 percent confidence intervals], 0.8 [0.6 to 1.0] and 0.3 [0.2 to 0.6], respectively).

"These findings can assist practitioners in identifying at-risk patients, guiding targeted interventions, and developing quality improvement initiatives aimed at identifying and reducing factors that impact avoidable pharmacologic restraint use in the pediatric inpatient environment," the authors write.