{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:57:04Z","timestamp":1792112224195,"version":"4.4.0"},"reference-count":47,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Research regarding disparities in physical restraint use in the emergency department (ED) is limited. We evaluated the role of race, ethnicity, and preferred language on the application of physical restraint among ED patients held under a Massachusetts section 12(a) order for mandatory psychiatric evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified all ED patient encounters with a section 12(a) order across a large integrated 11\u2010hospital health system from January 2018 through December 2019. Information on age, race, ethnicity, preferred language, insurance, mental illness, substance use, history of homelessness, and in\u2010network primary care provider was obtained from the electronic health record. We evaluated for differences in physical restraint use between subgroups via a mixed\u2010effect logistic regression with random\u2010intercept model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 32,054 encounters involving a section 12(a) order. Physical restraints were used in 2,458 (7.7%) encounters. Factors associated with physical restraint included male sex (adjusted odds ratio [aOR]\u00a0= 1.44, 95% confidence interval [CI]\u00a0= 1.28 to 1.63), Black\/African American race (aOR\u00a0= 1.22, 95% CI\u00a0= 1.01 to 1.48), Hispanic ethnicity (aOR\u00a0= 1.45, 95% CI\u00a0= 1.22 to 1.73), Medicaid insurance (aOR\u00a0= 1.21, 95% CI\u00a0= 1.05 to 1.39), and a diagnosis of bipolar disorder or psychotic disorder (aOR\u00a0= 1.51, 95% CI\u00a0= 1.31 to 1.74). Across all age groups, patients who were 25 to 34\u00a0years of age were at highest risk of restraint (aOR\u00a0= 2.01, 95% CI\u00a0= 1.69 to 2.39). Patients with a primary care provider within our network (aOR\u00a0= 0.81, 95% CI\u00a0= 0.72 to 0.92) were at lower risk of restraint. No associations were found between restraint use and language, history of alcohol or substance use, or homelessness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Black\/African American and Hispanic patients under an involuntary mandatory emergency psychiatric evaluation hold order experience higher rates of physical restraint in the ED. Factors contributing to racial disparities in the use of physical restraint, including the potential role of structural racism and other forms of bias, merits further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14327","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T11:20:15Z","timestamp":1631877615000},"page":"957-965","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":67,"title":["Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1450-0383","authenticated-orcid":false,"given":"Jossie A.","family":"Carreras Tartak","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Brisbon","sequence":"additional","affiliation":[{"name":"Data and Analytics Organization Mass General Brigham Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Wilkie","sequence":"additional","affiliation":[{"name":"Department of Quality and Patient Experience Mass General Brigham Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas D.","family":"Sequist","sequence":"additional","affiliation":[{"name":"Department of Quality and Patient Experience Mass General Brigham Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imoigele P.","family":"Aisiku","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women\u2019s Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Raja","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5752-2104","authenticated-orcid":false,"given":"Wendy L.","family":"Macias\u2010Konstantopoulos","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Center for Social Justice and Health Equity Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30569-X"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00381.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2012.05.010"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2015.08.052"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2020.00300"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.06.014"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.001877"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e31828e62f4"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000001430"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-0874-4"},{"key":"e_1_2_9_12_1","volume-title":"Agency for Healthcare Research and Quality website","author":"2018 National Healthcare Quality and Disparities Report","year":"2019"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302903"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.54.7.987"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2018.06.020"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-017-1697-6"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.4088\/PCC.19m02471"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14092"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674370304800509"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.19381"},{"issue":"1","key":"e_1_2_9_21_1","first-page":"e7","article-title":"Management of violence and aggression in emergency environment; 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