Frequency of Client and Staff Injury During Physical Restraint Episodes: A Comparison of 2 Child Restraint Systems

• Objective: To compare the frequency of injury to clients and staff with use of 2 restraint systems. • Design: Retrospective database review. • Setting and participants: Youth admitted under both voluntary and involuntary commitments to residential behavioral and mental health programs in Pennsylvania and New York and staff from these institutions. • Methods: Restraint events that occurred during 2003 were reviewed and stratified by method of restraint: Therapeutic Crisis Intervention (TCI) and Professional Crisis Management (PCM). Injuries caused during restraint applications were coded as serious (required in-house treatment) or critical (required transportation to medical center). Age, race, and sex of clients and restraint duration were determined. Group t tests and chi-square tests with restraint method as the independent variable were used to compare injury frequency and restraint duration between methods. Chi-square tests were used to compare the frequency of injury by hold method within each restraint system. • Results: There were 5580 restraint applications in the PCM group (n = 813) and 1274 in the TCI group (n = 194). The mean (SD) hold duration was significantly shorter for the PCM method (8.5 min [14.4] versus 15.1 min [13.7]; P < 0.001). TCI was associated with significantly more critical and serious client injuries (both, P < 0.001). No difference between PCM and TCI was noted for critical staff injuries (P = 0.404), although a trend toward significance was seen in serious staff injuries (P = 0.094). More injuries occurred at higher restraint levels with TCI than with PCM. • Conclusion: The PCM method was associated with a lower frequency of client injuries compared with the TCI method. We recommend the PCM method over TCI for use in children. Physical restraint of clients demonstrating or about to demonstrate aggressive or self-harmful behavior has been used for decades in both psychiatric and medical settings. It is well understood that clients need to be held on occasions when they are demonstrating behaviors that are thought to be of danger to themselves or others. A review article by Fisher found that restraint and seclusion use is effective in preventing injury and reducing agitation and that it is very difficult for organizations to run programs for youth without the use of physical/mechanical restraint or seclusion [1]. Further research is needed on the adverse effects associated with restraint use [2]. Previous studies have examined legal and ethical issues of restraint use in both the adult and child/youth populations [3–5], variables associated with restraint use [6–10], the incidence of restraint-related injuries in small versus large hospitals [9], and strategies to reduce the use of restraints and seclusion [11–17]. However, no studies have examined the relationship between the restraint method employed and client and staff injury. This study examines the occurrence of injury associated with 2 personal restraint systems.