Physical Restraint Use in a US Intensive Care Setting – Protocol for a retrospective cross-sectional analysis using the MIMIC-IV repository
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Objective
To investigate disparities in physical restraint use in a U.S. intensive care unit (ICU) setting, focusing on the influence of demographic factors (ethnicity, sex, age), mental health diagnoses, intubation status, and ICU type. The study also examines trends before and after policy changes in 2014.
Methods
This retrospective cross-sectional study uses MIMIC-IV data from adult ICU patients (2008–2022) at Beth Israel Deaconess Medical Center. The primary outcome is the proportion of ICU days with physical restraint. A binomial Generalized Linear Model (GLM) with a logit link function will be used to estimate associations between patient factors and the proportion of ICU time spent in restraints, modeling the number of days with restraint as a binomial outcome with the number of trials equal to the total ICU length of stay. Results will be reported as adjusted odds ratios with 95% confidence intervals. Temporal trends will be evaluated across predefined three-year intervals. Secondary analyses include binary restraint use (yes/no), death within 24 hours of restraint use (yes/no), interaction effects, and multiple sensitivity analyses.
