Incidência e fatores associados à contenção física em pacientes agitados e/ou agressivos em emergências psiquiátricas

Abstract

Agressive and/or agitated patients corresponds to 10% of all patients in psychiatric emergencies. Depending on the severity of the agitation, these patients represent a great risk not only for their physical integrity, but also for professionals. Use of restraints is one among several ways of dealing with these cases. Although it is largely used, its indication is not so clear and some countries not even allow such practice. In Brazil we don t have any protocol for this practice. The objective of this study is to learn about the frequency and the factors associated with this practice by doing a systematic review and a study in some emergency rooms in Rio de Janeiro. The systematic review identified only four studies, three from the United States and one conducted in India. The frequency of restraints in psychiatric emergency rooms went from 14% to 59% for aggressive/agitated patients. The studies considered in our systematic review were not conducted with the same purpose as ours and the statistical analyses were not appropriated for identifying associations. The study in the psychiatric emergencies in Rio de Janeiro showed provided information on the use of physical restraints among 298 participant patients of a randomized clinical trial comparing two different drugs to deal with cases of psicomotor agitation and aggressive behavior in these services. The analyzed variables were those collected before the entrance of the patient in the clinical trial. This was done to guarantee that variables preceded the doctor s decision to contain or not the patient. The analysis of the data made use of the Bayesian method. The prioris of the parameters used in the model of binary regression came from a similar study conducted in one of the three involved emergencies of the present study. The frequency in the use of the physical restraints was 24.5%, without difference between the three hospitals. The study also showed that younger patients, with more intense agitation, with suspicious initial diagnosis of abuse of substances and that they had been admitted in the morning presented a greater probability of being physically restrained. The present study points out the necessity to carry out other investigations specifically designed to evaluate the frequency and the factors associated with the use of physical restraint, aiming to subsidize the development of protocols on the use of physical restraints in our services.