Physical Restraint Use and Inpatient Outcomes Among AdultsWith a History of Child Abuse or Neglect

<title>Abstract</title> <p>Background: The association of physical restraint (PR) use in hospitalized adults with a history of child abuse or neglect (CON) is underexplored. Objective: To determine whether PRs were associated with worse hospital outcomes among adults with prior experience of CON. Participants and Setting: Using the 2022 National Inpatient Sample, we identified adults with a history of CON and compared those with and without PRs. Methods Multivariable regression analyses assessed in-hospital mortality, length of stay (LOS), total hospital charges, and discharge disposition. Results 74,640 adults with a history of CON were hospitalized. Among them, 1,725 (2.3%) had PRs. Physically restrained and unrestrained patients were of comparable ages (mean age 36.5 vs. 35.5 years, p = 0.16). A greater proportion of males and Blacks were restrained rather than unrestrained (46.1% vs. 35.6%; p &lt; 0.01) and (24.6% vs. 16.4%; p &lt; 0.01), respectively. Mortality was non-significantly higher in the PR group (adjusted Odds Ratio {aOR}=1.4, Confidence Interval {CI}: [0.3–6.9]; p = 0.63). Significantly longer LOS (adjusted Mean Difference {aMD} = +3.8 days, CI: [2.1–5.8]; p &lt; 0.01) and higher hospital charges were observed for PR patients ({aMD} = +$19,211, CI: [8,329 − 30,093]; p &lt; 0.01). PR patients had a lower adjusted odds of being discharged home compared to unrestrained patients ({aOR} = 0.57, CI: [0.41–0.78]; p &lt; 0.01). Conclusion Adults with a history of CON and PRs during hospitalization had inferior in-hospital resource utilization outcomes compared to the unrestrained. Interventions aimed at limiting PR use in this patient population should be the goal for care.</p>