Recent studies have highlighted a concerning trend in emergency department (ED) settings: people of color are more likely to be subjected to physical restraint compared to other patients. However, many of these studies are limited to a single site or healthcare system, raising questions about their broader applicability. Â
The objective of this research was to analyze existing literature on the risk of physical restraint use in adult EDs, particularly concerning patients of different racial and ethnic backgrounds. To achieve this, the researchers conducted a systematic search of several databases, including PubMed, Embase, Web of Science, and CINAHL, from database inception up to February 8, 2022.Â
The inclusion criteria for selected studies were as follows: (1) published in English, (2) original research involving human participants conducted in an adult ED, and (3) reporting of outcomes related to physical restraint use based on patient race or ethnicity. Studies conducted outside of the US or those without full-text availability were excluded.Â
Data from the chosen articles were abstracted by four independent reviewers following Meta-Analysis of Observational Studies in Epidemiology guidelines, with quality assessed using a modified Newcastle-Ottawa scale. In 2022, a meta-analysis was performed to analyze the risk of physical restraint use among minoritized racial and ethnic groups, using a random-effects model.Â
The main outcome measure was the risk of physical restraint use in adult ED patients based on their racial and ethnic backgrounds. The results indicated that out of 1,597 articles initially identified, only 10 met the inclusion criteria (representing 0.63% of the total). These studies encompassed 2,557,983 patient encounters, with 24,030 cases of physical restraint reported (0.94%).Â
In the meta-analysis, it was observed that Black patients were more likely to be subjected to restraint compared to White patients (Relative Risk [RR] 1.31, 95% Confidence Interval [CI] 1.19-1.43) and all non-Black patients (RR 1.27, 95% CI 1.23-1.31). In contrast, Hispanic patients were less likely to experience restraint compared to non-Hispanic patients (RR 0.85, 95% CI 0.81-0.89).Â
In conclusion, while physical restraint incidents were relatively rare, occurring in less than 1% of encounters, the research revealed a significant disparity: adult Black patients faced a notably higher risk of physical restraint in ED settings compared to other racial groups.
Conversely, Hispanic patients were less likely to be subjected to restraint compared to their non-Hispanic counterparts, though this difference might be influenced by the inclusion of Black patients in the non-Hispanic group. The study suggests the need for further investigation, including qualitative studies, to understand and address the underlying mechanisms of racism at interpersonal, institutional, and structural levels in healthcare settings.Â
Journal Reference Â
Eswaran V, Molina MF, Hwong AR, et al. Racial Disparities in Emergency Department Physical Restraint Use: A Systematic Review and Meta-Analysis. JAMA Intern Med. Published online September 25, 2023. doi:10.1001/jamainternmed.2023.4832Â
