J Clin Outcomes Manage
Frequency of client and staff injury during physical restraint episodes: a comparison of 2 child restraint systems
Henderson L, Siddons K, Wasser T, Gunn S, Spisszak E
Abstract 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.
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