January 2024 Pick of the Month

 

Evil Lurks in Necessity

This month's POTM, Pino et al.'s study on Disparities in the use of physical restraints at an urban, minority-serving hospital emergency department, revisits a topic previously addressed in a prior POTM (PMID: 34533261): the potential disparity in the use of physical restraints in emergency medicine. The findings are nuanced. Using chart review methodology, Pino et al. found that among all adults in their ED, there was a decrease in the odds of restraint use among Black and Hispanic patients compared with White patients. However, among patients with a documented history of mental illness or substance use disorder, the investigators found an increase in the use of restraints among female Black and Hispanic patients and among male Black patients (but not male Hispanic patients).

This work is significant as because it contributes additional data to an established and growing body of evidence demonstrating disparities in restraint use (PMID: 37747721). It can be reasonably conjectured that most ED physicians in active practice have a mixed opinion, recognizing that restraints are necessary to protect providers and staff from dangerous patients while also acknowledging that restraints can cause harm and be abused. Efforts to protect both patients and providers continue to increase the burden of documentation, social scrutiny, and civil liability of restraint use, even in pediatric EDs.

Undoubtedly, these data by Pino and colleagues will be valuable in future systematic reviews and in informing policies on restraint use in the ED setting at the local and perhaps national level.

 

Jeffrey A. Kline, MD
Wayne State University School of Medicine
Editor-in-Chief