• Ambrose H Wong, Taylor R Andrew RA Department of Emergency Medicine, Yale School of Medicine, New Haven, CT., Jessica M Ray, and Steven L Bernstein.
• Department of Emergency Medicine, Yale School of Medicine, New Haven, CT. Electronic address: wongambrose@gmail.com.
• Ann Emerg Med. 2019 Feb 1; 73 (2): 183-192.

Study ObjectiveThe prevalence of agitation among emergency department (ED) patients is increasing. Physical restraints are routinely used to prevent self-harm and to protect staff, but are associated with serious safety risks. To date, characterization of physical restraint use in the emergency setting has been limited. We thus aim to describe restraint patterns in the general ED to guide future investigation in the management of behavioral disorders.MethodsWe conducted a cross-sectional study of adult patients presenting to 5 adult EDs within a large regional health system for 2013 to 2015, and with a physical restraint order during their visit. We undertook descriptive analyses and cluster analysis to determine unique meaningful groups within our sample.ResultsIn 956,153 total ED visits, 4,661 patients (0.5%) had associated restraint orders, representing 3,739 unique patients. The median age was 47 years (interquartile range 32 to 59 years), 66.7% of patients were men, 61.9% had a psychiatric history, and 91.1% arrived by ambulance. For chief complaints, 33.7% were alcohol or drug use, 45.4% medical, 12.3% psychiatric, and 8.5% trauma. Cluster analysis identified 2 distinct cohorts. A younger, predominantly male population presented with alcohol or drug use, whereas an older group arrived with medical complaints.ConclusionOur data found strong association of alcohol or drug use with physical restraints and identified a unique elderly population with behavioral disturbances in the ED. Further characterization of causal links and safer practices to manage agitation for these vulnerable populations are needed.Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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