Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up?

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Abstract

Introduction: Agitation is frequently encountered in the emergency department (ED) and can range from psychomotor restlessness to overt aggression and violent behavior. Among all ED patients, 2.6% present with agitation or become agitated during their ED visit. We aimed to determine ED disposition for patients requiring agitation management with physical restraints. Methods: This was a retrospective cohort of all adult patients who presented to one of 19 EDs in a large integrated healthcare system and received agitation management with physical restraints between January 1, 2018-December 31, 2020. Categorical variables are presented as frequency and percentages, and continuous variables are presented as medians and interquartile range. Results: There were 3, 539 patients who had agitation management with physical restraints included in this study. In total 2, 076 (58.8%) were admitted to the hospital (95% CI [confidence interval] 0.572-0.605), and of those 81.4% were admitted to a primary medical floor and 18.6% were medically cleared and admitted to a psychiatric unit. Overall, 41.2% were able to be medically cleared and discharged from the ED. Mean age was 40.9 years, 2, 140 were male (59.1%), 1, 736 were White (50.3%), and 1, 527 (43%) were Black. We found 26% had abnormal ethanol, (95% CI 0.245-0.274) and 54.6% had an abnormal toxicology screen (95% CI 0.529-0.562). A significant number were administered a benzodiazepine or antipsychotic in the ED (88.44%) (95% CI 0.874-0.895). Conclusion: The majority of patients who had agitation management with physical restraints were admitted to the hospital; of those patients, 81.4% were admitted to a primary medical floor and 18.6% were admitted to a psychiatric unit.

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Simon, E. L., Smalley, C. M., Muir, M., Mangira, C. M., Pence, R., Wahi-Singh, B., … Fertel, B. S. (2023). Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up? Western Journal of Emergency Medicine, 24(3), 454–460. https://doi.org/10.5811/WESTJEM.59466

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