Physical restraints in critically ill children: Multicenter point prevalence study in Japan

• Project/Area Number: 19K24249
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Multi-year Fund
• Review Section: 0908:Society medicine, nursing, and related fields
• Research Institution: Osama Woman's and Children's Hospital
• Principal Investigator: Ryo Ikebe 地方独立行政法人大阪府立病院機構大阪母子医療センター(研究所), その他部局等, 看護部・ICU・主任 (90844308)
• Project Period (FY): 2019-08-30 – 2021-03-31
• Project Status: Completed (Fiscal Year 2020)
• Budget Amount: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2020: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000); Fiscal Year 2019: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
• Keywords: 身体拘束 / 小児集中治療 / 多施設前向き横断調査 / 実施率

Outline of Research at the Start

本研究は国内の多施設の集中治療室を対象とする横断研究である。
対象は、生後1ヶ月以上10歳未満の小児患者であり、全施設同時にデータを収集する。
オンラインデータ入力表(REDCap、アルバータ大学)を用いてデータ収集を行い、身体拘束の実施率等を調査する。
小児集中治療室や大学病院混合集中治療室等を含む26施設の参加が決定しており、参加施設ごとの属性、身体拘束発生率を記述することに加え、個々の患者と身体拘束に関連する因子を調査する。

Outline of Final Research Achievements

Objectives: We investigate the prevalence of, and elucidate the factors associated with, the use of physical restraints among critically ill or injured children in pediatric intensive care units. Design: This was a multicenter, longitudinal point prevalence study.Setting: We included 26 PICUs in Japan. Patients: Included children were aged 1 month to 10 years. We screened all admitted patients in the PICUs on three study dates.
Main Results: A total of 398 children were screened in the participating pediatric intensive care units on the three data collection dates. The prevalence of children with physical restraints was 53% (211/398). The adjusted odds of using physical restraint in patients aged 1-2 years was 2.3 (95% Cl, 1.3-4.0) compared with children <1-year-old. When looking at the individual hospital effect, units without a prespecified practice policy for physical restraints management, or those with more than 10 beds, were more likely to use physical restraints.

Academic Significance and Societal Importance of the Research Achievements

重症小児に対する身体拘束の実施率は高く、施設間での差が見られた。今回の研究結果から、患者の年齢、ユニットの規模、身体拘束の実践方針が、身体拘束の 実施率と関連している可能性が示唆された。
このことから、重症小児に対する身体拘束の実施基準作成や、施設間格差を是正する取り組みを行うことで、より快適、かつ質の高い重症小児に対する治療・療養環境の提供が可能となる。

Research Products

• [Journal Article] Physical Restraints in Critically Ill Children: A Multicenter Longitudinal Point Prevalence Study (2021)
  • Author(s): Ryo Ikebe, MEd, Atsushi Kawaguchi, MD, PhD, Tatsuya Kawasaki, MD, Norimasa Miura, RN, Yujiro Matsuishi, MS, Muneyuki Takeuchi, MD PhD, for the PRINCE Study Group and Innovative Support for Pediatric Intensive Care Research and Education (INSPIRED)
  • Journal Title: Critical Care Medicine Volume: -
  • Peer Reviewed
• [Presentation] Physical Restraints in Critically Ill Children: A Multicenter Longitudinal Point Prevalence Study (2020)
  • Author(s): Ryo Ikebe, MEd, Atsushi Kawaguchi, MD, PhD, Tatsuya Kawasaki, MD, Norimasa Miura, RN, Yujiro Matsuishi, MS, Muneyuki Takeuchi, MD PhD
  • Organizer: WFPICCS 2020 Virtual Congress December 1-4, 2020
  • Int'l Joint Research
• [Presentation] 小児集中治療における身体拘束についての横断調査 (2020)
  • Author(s): 池辺諒, 川口敦, 川崎達也, 三浦規雅, 松石雄二朗, 竹内宗之
  • Organizer: 第47回日本集中治療医学会学術集会
• [Presentation] Physical restraints in critically ill children: Multicenter point prevalence study in Japan (2020)
  • Author(s): Ryo Ikebe, Atsushi Kawaguchi, MD, PhD, Tatsuya Kawasaki, MD, Norimasa Miura, Yujiro Matsuishi, Muneyuki Takeuchi, MD, PhD
  • Organizer: 10th World Congress of the World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS20)
  • Int'l Joint Research