216 - Disparities in Pediatric Physical and Pharmacologic Restraint Use: Insights from a Tertiary Children’s Hospital

Publication Number: 1205.216

Van Don Williams II, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Brett R. Leingang, Corewell Health - Helen DeVos Children's Hospital, Ada, MI, United States; David C. Synhorst, Helen DeVos Children's Hospital, Rockford, MI, United States; Baila Harris, Helen DeVos Children's Hospital, Grand Rapids, MI, United States

Background: Pediatric mental and behavioral health (MBH) hospitalizations are increasing, and restraint use remains a critical safety and equity concern. Prior studies have focused on emergency or psychiatric settings, with limited data from general pediatric hospital medicine units. Understanding which patient and system factors drive restraint practices is essential to inform equitable, patient‑centered care.

Objective: To determine whether sociodemographic (sex, race/ethnicity, insurance), clinical (primary and co-morbid MBH diagnoses, length of stay), and operational (unit of admission) factors were independently associated with restraint type (physical vs pharmacologic) among hospitalized MBH patients.

Design/Methods: We conducted a retrospective cohort study of patients aged 3–21 years admitted with MBH diagnoses to a free‑standing children’s hospital (2017–2023). Demographic, clinical, insurance, and unit data were extracted from the electronic health record. The primary outcome was restraint type, classified as physical (any documented physical restraint order, with or without pharmacologic use) versus pharmacologic (intramuscular or intravenous antipsychotic/sedative given PRN for acute agitation, without physical restraint). Associations were assessed using chi‑square tests and multivariable logistic regression.

Results: Of 376 eligible patients, 205 (54.5%) received pharmacologic restraints and 171 (45.5%) physical restraints. Male sex, public insurance, co-morbid MBH diagnoses, and longer stays were significantly associated with physical restraint (all p < .001). In adjusted models, public insurance more than doubled the odds of physical restraint (OR 2.23, 95% CI 1.37–3.64). Hospitalizations ≤7 days were associated with lower odds (OR 0.43, 95% CI 0.26–0.71), while co-morbid MBH diagnoses increased odds nearly fourfold (OR 3.7, 95% CI 0.94–14.7). Admission to the pediatric behavioral health unit (Unit 5) was strongly associated with physical restraint compared to general pediatric units (Units 1–4). No significant differences were observed by race or ethnicity.

Conclusion(s): Children with public insurance and greater diagnostic complexity were disproportionately subjected to physical restraints, highlighting the influence of socioeconomic and operational factors on care. While racial differences were not statistically significant, observed trends align with broader inequities in pediatric behavioral health. Findings underscore the need for standardized, equity focused restraint policies and staff training across both behavioral health and general pediatric units.