TOPLINE

Mechanical restraint during inpatient psychiatric care, such as with waist belts and wrist straps, was associated with more than twice the risk for venous thromboembolism (VTE) within 30 days compared with chemical restraint, a new study showed.

METHODOLOGY

• A population-based cohort study and a self-controlled case series using data from national registries and psychiatric hospitals was conducted in Denmark from 2000 to 2022.
• Adult inpatients exposed to mechanical restraint (n = 10,208) or chemical restraint (n = 14,215) were included in the cohort study. The self-controlled case series included 1285 patients with incident VTE occurring at baseline or during risk periods after mechanical restraint.
• Mechanical restraint included physical fixation by waist belts, either alone or in combination with wrist straps, ankle straps, or gloves; chemical restraint was comprised of sedative drugs given by force.
• The primary outcome of the cohort study was cumulative incidence of VTE (incident and recurrent VTE events) identified through hospital data. Secondary outcomes included incident VTE only and incident all-cause mortality. Risk for VTE was evaluated primarily at 30 days after restraint.
• The self-controlled case series compared incidence of VTE during risk periods up to 90 days after restraint (divided into 0-14 days, 15-29 days, and 30-90 days) with incidence during the baseline period (15 days before restraint).

TAKEAWAY

• In the cohort study, at 30 days after restraint, the cumulative incidence of VTE was higher in the mechanical restraint group than in the chemical restraint group (3.5 vs 1.7 per 1000 patients; risk ratio [RR], 2.07), as were the risks for incident VTE (RR, 1.91; risk difference [RD], 1.3 per 1000 patients) and all-cause mortality (RR, 1.16; RD, 2.9 per 1000 patients).
• In the case series, 1175 VTE events occurred at baseline and 85 occurred within 90 days after mechanical restraint. The incidence of VTE was higher in the 14 days after mechanical restraint than at baseline (incidence rate ratio [IRR], 4.49), declining during days 15-29 (IRR, 1.64) and days 30-90 (IRR, 0.92).
• Men (IRR, 5.85) and patients restrained during 2011-2022 (IRR, 5.96) had the highest incidence of VTE during the 14 days following mechanical restraint. However, incidence during the 14 days following restraint did not differ significantly between the group of patients aged 60 years or older and the group aged 18-59 years.

IN PRACTICE

The authors of an accompanying editorial wrote that although both forms of restraint may increase VTE risk in this patient population, the findings showed a stronger risk for mechanical restraint.

“Given these potential harms and the continued uncertainty around VTE risk assessment and prevention in this patient group, it seems imperative to reduce the use of a key modifiable risk factor such as mechanical restraint,” they added.

SOURCE

The study was led by Jakob Hansen Viuff, PhD, Centre for Population Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. Lead author of the editorial was Christoph Mueller, King’s College London, London, England. Both articles were published online on July 1 in BMJ.

LIMITATIONS

The study was limited by a lack of data on voluntary antipsychotic treatment during hospital stay and lifestyle factors, underreporting of VTE cases, and potential confounding by indication.

DISCLOSURES

The study was funded by the Independent Research Fund Denmark. Disclosure information for study investigators and authors of the editorial is available in the original articles.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.