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The Use of Restraints and Excited Delirium or Positional Asphyxia: A Review of the Safety and Guidelines

Last updated: August 11, 2016
Project Number: RC0801-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report


  1. What is the safety of restraints or restraining methods for people in custody or in healthcare facilities?
  2. What are the evidence-based guidelines for the prevention or management of excited delirium?
  3. What are the evidence-based guidelines for the prevention or management of positional asphyxia?

Key Message

One low quality systematic review, one fair quality randomized controlled trial and four cohort studies of varying quality address the safety of use of physical restraints on individuals in custody or in the health care system. Evidence from these studies demonstrate that adverse effects such as patient injury and psychological trauma are risks of physical restraint. The incidence of these adverse outcomes varies depending on the setting and was reported to be as high as 35%. One cohort study demonstrated that a prolonged period of restraint (72 hours) is associated with the development of deep vein thrombosis. Restraint related death was low in the included studies and was not significantly different based on position of the patient (prone vs. non-prone). One poor quality consensus guideline was included that addressed the management of excited delirium in the emergency department. Goals of management include de-escalation techniques and supportive care directed at treating symptoms and addressing physiological derangements. There was no evidence that met the inclusion criteria for this review that addressed prevention or management of positional asphyxia