Physical Restraints in Critically Ill Children: A Multicenter Longitudinal Point Prevalence Study

Abstract

Objectives: We elucidate to investigate the prevalence of and factors associated with the use of physical restraints among critically ill or injured children in PICUs.

Design: This was a multicenter, longitudinal point prevalence study.

Setting: We included 26 PICUs in Japan.

Patients: Included children were 1 month to 10 years old. We screened all admitted patients in the PICUs on three study dates (in March, June, and September 2019).

Intervention: None.

Measurements and main results: We collected prevalence and demographic characteristics of critically ill or injured children with physical restraints, as well as details of physical restraints, including indications and treatments provided. A total of 398 children were screened in the participating PICUs on the three data collection dates. The prevalence of children with physical restraints was 53% (211/398). Wrist restraint bands were the most frequently used means (55%, 117/211) for potential contingent events. The adjusted odds of using physical restraint in patients 1-2 years old was 2.3 (95% CI, 1.3-4.0) compared with children less than 1 year old. When looking at the individual hospital effect, units without a prespecified practice policy for physical restraints management or those with more than 10 beds were more likely to use physical restraints.

Conclusions: The prevalence of physical restraints in critically ill or injured children was high, and significant variation was observed among PICUs. Our study findings suggested that patient age, unit size, and practice policy of physical restraint could be associated with more frequent use of physical restraints.