Emergency departments show racial disparities in the use of physical restraints, with Black patients experiencing restraint 31% more often than White patients, according to a study in JAMA Internal Medicine. Although restraint use is rare (around 1% of cases), it raises concerns due to potential harm. The study highlights the need for further research to understand the underlying causes, such as racial bias, and develop strategies to address these disparities. Limited data suggests that this area remains understudied in medical and health equity research.
According to a recent article in JAMA Internal Medicine, the use of restraints in emergency rooms shows a concerning imbalance between Black patients and others, suggesting potential physical and psychological harm. Even while restraint use is uncommon—it occurs in only approximately 1% of cases—its negative effects make it important to pay attention to. Restraints, which are defined as mechanical devices limiting voluntary patient movement, are occasionally required for safety, according to researchers from the University of California Davis, the University of California San Francisco, and Baylor College of Medicine.
However, their use can lead to complications such as aspiration, thromboembolic events, choking, physical trauma, and psychological distress. Moreover, individuals who experience restraint may develop reduced trust in the healthcare system, particularly if they belong to historically marginalized racial or ethnic groups. To explore this issue further, the researchers conducted a comprehensive literature review, identifying ten studies that met specific criteria, including publication in English, involvement of adult emergency department patients, and reporting of restraint outcomes by patient race or ethnicity.
Despite the overall rarity of physical restraint use (occurring in 1% of nearly 2.5 million patient encounters), the researchers found that Black patients experienced restraint 31% more often than White patients. Four studies indicated a positive association between Black race and restraint use, one found no relationship, and another found a positive link between multiracial background and restraint use, consistent with research in pediatric emergency departments.
The study did not delve into the underlying reasons behind this racial disparity, but it raised hypotheses, including the possibility of racial bias. These disparities might reflect racial dynamics in the emergency department and the mental and behavioral health space. Black patients might face misdiagnoses of psychotic disorders, limited access to behavioral health treatment, and more severe illness due to restricted access to outpatient mental healthcare, increasing their risk of restraint.
Implicit bias could also be a factor, although the researchers did not extensively explore this aspect. Vidya Eswaran, MD, MAS, the paper’s corresponding author and an assistant professor of emergency medicine at Baylor, emphasized the need for further research to understand the mechanisms driving these differences and develop strategies to mitigate them.
The study acknowledged the limited quality of available data, with only a few studies meeting the criteria for inclusion in the report. This suggests that racial disparities in restraint use in the emergency department remain an inadequately studied area within medical and health equity research.
