Pediatric Physical Restraint Coding in US Hospitals: A 2019 Kids Inpatient Database Study

• Published in: Hospital pediatrics Vol. 14; no. 5; p. 337
• Main Authors: Luccarelli, James, Kalluri, Aditya S, Kalluri, Nikita S, McCoy, Jr, Thomas H
• Format: Journal Article
• Language: English
• Published: United States 01.05.2024
• Subjects: Adolescent; Child; Child, Preschool; Clinical Coding; Databases, Factual; Female; Hospitalization - statistics & numerical data; Humans; Infant; Male; Restraint, Physical - statistics & numerical data; United States - epidemiology; United States
• ISSN: 2154-1671
• DOI: 10.1542/hpeds.2023-007562

Reduction of physical restraint utilization is a goal of high-quality hospital care, but there is little nationally-representative data about physical restraint utilization in hospitalized children in the United States. This study reports the rate of physical restraint coding among hospitalizations for patients aged 1 to 18 years old in the United States and explores associated demographic and diagnostic factors. The Kids' Inpatient Database, an all-payors database of community hospital discharges in the United States, was queried for hospitalizations with a diagnosis of physical restraint status in 2019. Logistic regression using patient sociodemographic characteristics was used to characterize factors associated with physical restraint coding. A coded diagnosis of physical restraint status was present for 8893 (95% confidence interval [CI]: 8227-9560) hospitalizations among individuals aged 1 to 18 years old, or 0.63% of hospitalizations. Diagnoses associated with physical restraint varied by age, with mental health diagnoses overall the most frequent in an adjusted model, male sex (adjusted odds ratio [aOR] 1.56; 95% CI: 1.47-1.65), Black race (aOR 1.43; 95% CI: 1.33-1.55), a primary mental health or substance diagnosis (aOR 7.13; 95% CI: 6.42-7.90), Medicare or Medicaid insurance (aOR 1.33; 95% CI: 1.24-1.43), and more severe illness (aOR 2.83; 95% CI: 2.73-2.94) were associated with higher odds of a hospitalization involving a physical restraint code. Physical restraint coding varied by age, sex, race, region, and disease severity. These results highlight potential disparities in physical restraint utilization, which may have consequences for equity.