Racial Disparities in Emergency Department Physical Restraint Use: A Systematic Review and Meta-Analysis
Abstract
Importance
Recent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of these studies are based at a single site or health care system, limiting their generalizability.
Objective
To synthesize existing literature on risk of physical restraint use in adult EDs, specifically in reference to patients of different racial and ethnic backgrounds.
Data Sources
A systematic search of PubMed, Embase, Web of Science, and CINAHL was performed from database inception to February 8, 2022.
Study Selection
Included peer-reviewed studies met 3 criteria: (1) published in English, (2) original human participants research performed in an adult ED, and (3) reported an outcome of physical restraint use by patient race or ethnicity. Studies were excluded if they were conducted outside of the US, or if full text was unavailable.
Data Extraction and Synthesis
Four independent reviewers (V.E., M.M., D.D., and A.H.) abstracted data from selected articles following Meta-Analysis of Observational Studies in Epidemiology guidelines. A modified Newcastle-Ottawa scale was used to assess quality. A meta-analysis of restraint outcomes among minoritized racial and ethnic groups was performed using a random-effects model in 2022.
Main Outcome(s) and Measure(s)
Risk of physical restraint use in adult ED patients by racial and ethnic background.
Results
The search yielded 1597 articles, of which 10 met…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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