Pediatric Emergency Medicine Attending Physician Nationwide Children's Hospital Columbus, Ohio, United States
Background: Pediatric patients with mental and behavioral health (MBH) emergencies can develop acute agitation and behavioral disturbances necessitating the use of pharmacologic or physical restraints. The prevalence of restraint use by emergency medical services (EMS) for pediatric MBH emergencies has increased over the last decade. Prior studies have identified disparities in restraint use for MBH emergencies in the adult emergency department (ED) setting, however, little is known about disparities in pre-hospital pediatric restraint use. Objective: To evaluate disparities by age, sex, race, ethnicity, and language in pre-hospital restraint use for pediatric MBH concerns. Design/Methods: This was a retrospective cohort study of patients aged 0-17 years who were transported by a large EMS system to a quaternary care pediatric ED for MBH concerns between January 1st 2011 to December 31st 2023. We excluded patients who were prisoners. Data was collected from a pre-existing unified database that utilized probabilistic data linkage to match EMS patient care reports to hospital electronic medical records. Summary statistics were used to summarize patient demographics. Univariate and multivariate logistic regression analyses were used to investigate associations between patient demographics and EMS restraint use. Results: A total of 1615 EMS MBH encounters were included. Of these, most were female (72.1%) with median age of 14 years (Table 1). The majority self-identified as Black or African American (42.2%), non-Hispanic/Latino (92.4%) and were English speaking (93.6%). A total of 157 (9.7%) received any type of EMS restraints; 98 (62.4%) received physical restraints only, 28 (17.8%) received pharmacologic restraints only, and 31 (20.4%) received both physical and pharmacologic restraints. Univariate analysis of restraint use revealed that children of male sex, Black race, and non-English primary language other than Spanish or Somali had significantly higher odds of receiving restraints (Table 1). Older children had lower odds of receiving restraints than younger children. Multivariate analysis revealed children of younger age, male sex, and Black race had significantly higher odds of receiving any type of restraint (Table 2).
Conclusion(s): In this large cohort of children transported for MBH concerns by a single EMS agency, age, sex and race correlated with prehospital restraint use. Future multi-centered research is needed to determine the cause of these disparities and to inform interventions that improve healthcare equity and promote safety for this vulnerable population.
Table 1. Univariate analysis of variables associated with any type of pre-hospital restraint use PAS EMS restraint table 1.jpeg
