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

Abstract

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. 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. 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). 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.