Pharmacologic Restraint Use During Mental Health Visits in Pediatric Emergency Departments

Foster, Ashley; Porter, John J.; Monuteaux, Michael C.; Hoffmann, Jennifer A.; Hudgins, Joel

doi:10.1016/j.jpeds.2021.03.027

Cited by 41 publications

(71 citation statements)

References 41 publications

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“…In this volume of The Journal, Foster et al report an evaluation of the trends in pharmacologic restraint use from 32 hospitals in patients aged 3-21 years who presented to the emergency department for a mental health concern between 2009 and 2019. 4 Earlier studies report data from single centers over a shorter period of time, and a study of this magnitude provides hospitals the ability to benchmark their use of pharmacologic restraint to national trends. Pharmacologic restraints in this study were defined as medications cited in the literature as being used for pediatric pharmacologic restraint and administered intramuscularly or intravenously.…”

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confidence: 99%

“…Foster et al found that pharmacologic restraint occurred in 3.5% of emergency department mental health visits, but the variability in rates of restraint use among hospitals was large (1.6%-11.8%), with a median of 4.1%. 4 The rate of mental health visits to emergency departments increased 268% (compared with 14.5% increase in nonmental health visits), whereas the rate of visits associated with pharmacologic restraint increased 370% between 2009 and 2019. Benzodiazepines were used most commonly administered (56.0%), followed by antipsychotic medications (46.2%) and antihistamines (32.0%).…”

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confidence: 99%

“…Foster et al also compared characteristics of the visits associated with and without pharmacologic restraint use. 4 In cases in which restraint was used, admission rates for hospitalization were greater, which may indicate a level of severity. In addition, there was a greater proportion of restraint use for patients who were Black and patients with non-Latino ethnicity.…”

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confidence: 99%

“…5 Foster et al found that benzodiazepines were the most commonly used medication for restraint. 4 Although the specific indications and frequency of particular benzodiazepines used were not reported, it is important to keep in mind that somewhat-unpredictable, paradoxical reactions can occur in youth treated with benzodiazepines. 9 In the midst of patient J.V.V.…”

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confidence: 99%

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Benchmarking and Optimizing Pharmacologic Restraint for Agitated Youth in the Emergency Medicine Department

Voort

Croarkin

2021

The Journal of Pediatrics

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Benchmarking and Optimizing Pharmacologic Restraint for Agitated Youth in the Emergency Medicine Department

Voort

Croarkin

2021

The Journal of Pediatrics

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“…Similarly, Black race has been demonstrated to be associated with pharmacologic restraint use in pediatric emergency settings (Foster et al, 2021).…”

Section: Previous Studiesmentioning

confidence: 99%

Considering trends of restraints and seclusions by patient race

Victor¹,

Brannan²,

Hunt³

et al. 2021

Child Adolescent Behavior

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Mental Health Revisits at US Pediatric Emergency Departments

et al. 2023

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ImportancePediatric emergency department (ED) visits for mental health crises are increasing. Patients who frequently use the ED are of particular concern, as pediatric mental health ED visits are commonly repeat visits. Better understanding of trends and factors associated with mental health ED revisits is needed for optimal resource allocation and targeting of prevention efforts.ObjectiveTo describe trends in pediatric mental health ED visits and revisits and to determine factors associated with revisits.Design, Setting, and ParticipantsIn this cohort study, data were obtained from 38 US children’s hospital EDs in the Pediatric Health Information System between October 1, 2015, and February 29, 2020. The cohort included patients aged 3 to 17 years with a mental health ED visit.ExposuresCharacteristics of patients, encounters, hospitals, and communities.Main Outcomes and MeasuresThe primary outcome was a mental health ED revisit within 6 months of the index visit. Trends were assessed using cosinor analysis and factors associated with time to revisit using mixed-effects Cox proportional hazards regression.ResultsThere were 308 264 mental health ED visits from 217 865 unique patients, and 13.2% of patients had a mental health revisit within 6 months. Mental health visits increased by 8.0% annually (95% CI, 4.5%-11.4%), whereas all other ED visits increased by 1.5% annually (95% CI, 0.1%-2.9%). Factors associated with mental health ED revisits included psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and presence of an inpatient psychiatric unit at the presenting hospital. Patients with psychotic disorders (hazard ratio [HR], 1.42; 95% CI, 1.29-1.57), disruptive or impulse control disorders (HR, 1.36; 95% CI, 1.30-1.42), and neurodevelopmental disorders (HR, 1.22; 95% CI, 1.14-1.30) were more likely to revisit. Patients with substance use disorders (HR, 0.60; 95% CI, 0.55-0.66) were less likely to revisit.Conclusions and RelevanceMarkers of disease severity and health care access were associated with mental health revisits. Directing hospital and community interventions toward identified high-risk patients is needed to help mitigate recurrent mental health ED use and improve mental health care delivery.

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Pharmacologic Restraint Use During Mental Health Visits in Pediatric Emergency Departments

Cited by 41 publications

References 41 publications

Benchmarking and Optimizing Pharmacologic Restraint for Agitated Youth in the Emergency Medicine Department

Benchmarking and Optimizing Pharmacologic Restraint for Agitated Youth in the Emergency Medicine Department

Considering trends of restraints and seclusions by patient race

Mental Health Revisits at US Pediatric Emergency Departments

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