Black children are almost twice as likely to be physically restrained in the emergency department compared with White children, according to a research letter published this week in JAMA Pediatrics. Use of physical restraints is an uncommon but serious intervention that has been found to increase the risk of injury, trauma, and death.
“Racial and ethnic disparities in restraint use likely reflect racism at multiple levels within and beyond the emergency care continuum,” wrote Katherine A. Nash, M.D., of Yale University School of Medicine and colleagues. “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.”
The researchers examined the health records of nearly 552,000 emergency department visits by children from less than a year old to age 16 at 11 emergency departments within a New England health care system between 2013 and 2020. They found that physical restraints were ordered for 532 visits (0.1%). The majority of the children who were physically restrained were publicly insured, had a behavioral health problem, and were males above the age of 10.
Results were adjusted for age, sex, language spoken, insurance, school month, behavioral health presenting problem, presence of an outpatient psychotropic medication, and history of behavioral health condition. They found that emergency department staff were 1.8 times more likely to use physical restraints on Black pediatric patients than White pediatric patients. They found no difference in the use of physical restraints on White versus Hispanic pediatric patients.
The researchers noted that previous research showed that Black adult patients are also more likely to be physically restrained in emergency rooms. Physical restraint should be used only after trying behavior de-escalation or chemical restraint, they added.
“Documenting racial and ethnic inequities is important but insufficient,” the authors 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.”
For related information, see the Psychiatric Services article “The Role of the Psychiatrist in Seclusion and Restraint.”
