Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
Journal
Journal of hospital medicine
ISSN: 1553-5606
Titre abrégé: J Hosp Med
Pays: United States
ID NLM: 101271025
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
revised:
26
10
2022
received:
18
07
2022
accepted:
30
10
2022
pmc-release:
01
02
2024
pubmed:
24
11
2022
medline:
8
2
2023
entrez:
23
11
2022
Statut:
ppublish
Résumé
Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use. To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient-level and demographic factors. Cluster analysis (k-means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital-level factors for pharmacologic restraint use were compared. Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital-level analysis. Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10-fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.
Sections du résumé
BACKGROUND
Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use.
OBJECTIVE
To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals.
DESIGN, SETTING, AND PARTICIPANTS
We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient-level and demographic factors. Cluster analysis (k-means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital-level factors for pharmacologic restraint use were compared.
RESULTS
Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital-level analysis.
CONCLUSIONS
Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10-fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.
Identifiants
pubmed: 36415909
doi: 10.1002/jhm.13009
pmc: PMC9899307
mid: NIHMS1853851
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
120-129Subventions
Organisme : NIAID NIH HHS
ID : K23 AI168496
Pays : United States
Organisme : AHRQ HHS
ID : T32 HS026122
Pays : United States
Organisme : NIAID NIH HHS
ID : K23 AI168496
Pays : United States
Organisme : AHRQ HHS
ID : T32HS026122
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 Society of Hospital Medicine.
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