Treatment of pediatric behavioral health patients with intravenous and intramuscular chemical restraints: Results from a nationwide sample of emergency departments.
Treatment of pediatric behavioral health patients with intravenous and intramuscular chemical restraints: Results from a nationwide sample of emergency departments.
复制标题
采用静脉内和肌肉内化学约束治疗儿童行为健康患者：来自全国急诊科样本的结果。
DOI：
10.1111/acem.14754
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Westafer,LaurenM
中科院分区：
文献类型：
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作者：
Tang,AndrewS;Shieh,Meng-Shiou;Pekow,PenelopeS;Prentiss,KimballA;Lindenauer,PeterK;Westafer,LaurenM
背景儿科急诊科患者的行为健康危机日益普遍。对于对自己或他人构成迫在眉睫的危险的患者，可以使用化学限制措施。我们试图在全国范围内的医院样本中描述静脉(IV)/肌肉(IM)化学约束对儿童行为健康ED患者的使用情况，并描述与约束使用相关的因素。方法：这是一项对2018年1月1日至2020年12月31日期间在822家急诊室接受治疗的8-17岁患者的回顾性研究，这些患者向Premier Healthcare数据库提供了数据，并被诊断为行为健康出院。主要结果是使用静脉/肌注化学约束药物。结果在630,384例患者中，4.8%的患者接受了静脉/肌注化学约束药物治疗。与较高的化学抑制几率相关的患者因素是年龄较大(13-17 岁[调整后的优势比1.53，95%可信区间1.48-1.58])、焦虑症(优势比1.69，95%可信区间1.64-1.74)、破坏性障碍(优势比1.61，95%可信区间1.53-1.69)、自杀/自残(优势比1.3，95%可信区间1.26-1.34)、药物使用(优势比1.24，95%可信区间1.20-1.28)、双相情感障碍(AOR 1.23，95%CI 1.17~1.30)。有复杂合并症的参与者更有可能接受化学限制(AOR 1.32，95%CI 1.26-1.39)。在调整了患者和医院因素后，表明个别医院对化学约束的影响的中位数OR为1.43(95%CI 1.40~1.47)。结论在儿童行为健康急诊科就诊期间，年龄和某些行为健康诊断与接受IV/IM化学约束有关。此外，患者是否接受了化学限制治疗，很大程度上受到他们所在医院的影响。
BackgroundBehavioral health crises in pediatric emergency department (ED) patients are increasingly common. Chemical restraints can be utilized for patients who present imminent danger to self or others. We sought to describe the use of intravenous (IV)/intramuscular (IM) chemical restraints for pediatric behavioral health ED patients across a nationwide sample of hospitals and describe factors associated with restraint use.MethodsThis was a retrospective study of patients ages 8–17 treated at 822 EDs contributing data to the Premier Healthcare Database between January 1, 2018, and December 31, 2020, with a behavioral health discharge diagnosis. The primary outcome was the use of IV/IM chemical restraint medication. We developed a hierarchical model to examine patient and hospital‐level factors associated with treatment with IV/IM chemical restraint medications.ResultsOf 630,384 cases, 4.8% received IV/IM chemical restraint. Patient factors associated with higher odds of chemical restraint were older age (ages 13–17 years [adjusted odds ratio {AOR} 1.53, 95% confidence interval {CI} 1.48–1.58]), anxiety disorders (AOR 1.69, 95% CI 1.64–1.74), disruptive disorders (AOR 1.61, 95% CI 1.53–1.69), suicide/self‐injury (AOR 1.3, 95% CI 1.26–1.34), substance use (AOR 1.24, 95% CI 1.20–1.28), and bipolar disorder (AOR 1.23, 95% CI 1.17–1.30). Participants with complex comorbidities were more likely to receive chemical restraint (AOR 1.32, 95% CI 1.26–1.39). After patient and hospital factors were adjusted for, the median OR indicating the influence of the individual hospital on the odds of chemical restraint was 1.43 (95% CI 1.40–1.47).ConclusionsWe found that age and certain behavioral health diagnoses were associated with receipt of IV/IM chemical restraint during pediatric behavioral health ED visits. Additionally, whether a patient was treated with chemical restraints was strongly influenced by the hospital to which they presented for treatment.