Racial Disparities in Emergency Department Physical Restraint Use: A Systematic Review and Meta-Analysis

Recent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of these studies are based at a single site or health care system, limiting their generalizability. To synthesize existing literature on...

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Published inJAMA internal medicine Vol. 183; no. 11; p. 1229
Main Authors Eswaran, Vidya, Molina, Melanie F, Hwong, Alison R, Dillon, David G, Alvarez, Lizbeth, Allen, Isabel E, Wang, Ralph C
Format Journal Article
LanguageEnglish
Published United States 01.11.2023
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Abstract Recent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of these studies are based at a single site or health care system, limiting their generalizability. To synthesize existing literature on risk of physical restraint use in adult EDs, specifically in reference to patients of different racial and ethnic backgrounds. A systematic search of PubMed, Embase, Web of Science, and CINAHL was performed from database inception to February 8, 2022. Included peer-reviewed studies met 3 criteria: (1) published in English, (2) original human participants research performed in an adult ED, and (3) reported an outcome of physical restraint use by patient race or ethnicity. Studies were excluded if they were conducted outside of the US, or if full text was unavailable. Four independent reviewers (V.E., M.M., D.D., and A.H.) abstracted data from selected articles following Meta-Analysis of Observational Studies in Epidemiology guidelines. A modified Newcastle-Ottawa scale was used to assess quality. A meta-analysis of restraint outcomes among minoritized racial and ethnic groups was performed using a random-effects model in 2022. Risk of physical restraint use in adult ED patients by racial and ethnic background. The search yielded 1597 articles, of which 10 met inclusion criteria (0.63%). These studies represented 2 557 983 patient encounters and 24 030 events of physical restraint (0.94%). In the meta-analysis, Black patients were more likely to be restrained compared with White patients (RR, 1.31; 95% CI, 1.19-1.43) and to all non-Black patients (RR, 1.27; 95% CI, 1.23-1.31). With respect to ethnicity, Hispanic patients were less likely to be restrained compared with non-Hispanic patients (RR, 0.85; 95% CI, 0.81-0.89). Physical restraint was uncommon, occurring in less than 1% of encounters, but adult Black patients experienced a significantly higher risk of physical restraint in ED settings compared with other racial groups. Hispanic patients were less likely to be restrained compared with non-Hispanic patients, though this observation may have occurred if Black patients, with a higher risk of restraint, were included in the non-Hispanic group. Further work, including qualitative studies, to explore and address mechanisms of racism at the interpersonal, institutional, and structural levels are needed.
AbstractList Recent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of these studies are based at a single site or health care system, limiting their generalizability. To synthesize existing literature on risk of physical restraint use in adult EDs, specifically in reference to patients of different racial and ethnic backgrounds. A systematic search of PubMed, Embase, Web of Science, and CINAHL was performed from database inception to February 8, 2022. Included peer-reviewed studies met 3 criteria: (1) published in English, (2) original human participants research performed in an adult ED, and (3) reported an outcome of physical restraint use by patient race or ethnicity. Studies were excluded if they were conducted outside of the US, or if full text was unavailable. Four independent reviewers (V.E., M.M., D.D., and A.H.) abstracted data from selected articles following Meta-Analysis of Observational Studies in Epidemiology guidelines. A modified Newcastle-Ottawa scale was used to assess quality. A meta-analysis of restraint outcomes among minoritized racial and ethnic groups was performed using a random-effects model in 2022. Risk of physical restraint use in adult ED patients by racial and ethnic background. The search yielded 1597 articles, of which 10 met inclusion criteria (0.63%). These studies represented 2 557 983 patient encounters and 24 030 events of physical restraint (0.94%). In the meta-analysis, Black patients were more likely to be restrained compared with White patients (RR, 1.31; 95% CI, 1.19-1.43) and to all non-Black patients (RR, 1.27; 95% CI, 1.23-1.31). With respect to ethnicity, Hispanic patients were less likely to be restrained compared with non-Hispanic patients (RR, 0.85; 95% CI, 0.81-0.89). Physical restraint was uncommon, occurring in less than 1% of encounters, but adult Black patients experienced a significantly higher risk of physical restraint in ED settings compared with other racial groups. Hispanic patients were less likely to be restrained compared with non-Hispanic patients, though this observation may have occurred if Black patients, with a higher risk of restraint, were included in the non-Hispanic group. Further work, including qualitative studies, to explore and address mechanisms of racism at the interpersonal, institutional, and structural levels are needed.
Author Eswaran, Vidya
Hwong, Alison R
Dillon, David G
Molina, Melanie F
Allen, Isabel E
Alvarez, Lizbeth
Wang, Ralph C
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  organization: Department of Emergency Medicine, University of California, San Francisco
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Snippet Recent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but...
SourceID pubmed
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StartPage 1229
SubjectTerms Adult
Black or African American - statistics & numerical data
Delivery of Health Care - ethnology
Delivery of Health Care - statistics & numerical data
Emergency Service, Hospital - statistics & numerical data
Ethnicity - statistics & numerical data
Healthcare Disparities - ethnology
Hispanic or Latino - statistics & numerical data
Humans
Restraint, Physical - statistics & numerical data
White - statistics & numerical data
Title Racial Disparities in Emergency Department Physical Restraint Use: A Systematic Review and Meta-Analysis
URI https://www.ncbi.nlm.nih.gov/pubmed/37747721
Volume 183
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