Volume 80, June 2024, Pages 44-50Author links open overlay panel, , , AbstractIntroduction

Aggression and violence are major concerns in emergency departments (EDs), and have negative consequences for patient and staff health and safety. Few validated tools exist for identifying patients at risk of agitation. This study conducted a systematic literature review to identify and summarize the scores that predict aggressive behavior in EDs.

Methods

The search included articles published between Jan 1st, 1987, and Dec 31st, 2022, using the terms “aggress*,” “violent*,” “emergency,” “acute,” “score,” or “scale.”

Results

Ten scores were found to be relevant, with eight of the developed scores intended for use in EDs. The Aggressive Behavior Risk Assessment Tool (ABRAT) was found to be sensitive (84.3%) and specific (95.3%). The Brøset Violence Checklist (BVC) was highly specific (99.4%), whereas the Violence Screening Checklist (VSC) was less sensitive (57.2%) and specific (45.7%). The violence and aggression (OVA)/BVC checklist was found to significantly decrease the number of security call activations (P < 0.001). The Behavioral Activity Rating Scale (BARS) and OVA/BVC scores were the shortest, with seven and six items, respectively.

Conclusion

The OVA/BVC checklist is a valuable tool for predicting and preventing violence in the EDs. Future prospective studies should investigate its effectiveness.

Section snippetsBackground

Over the last decade, the incidence of mental illness has increased in the United States, while available services and funding are either stagnant or dwindling. This has created challenges in providing optimal care for Emergency Department (ED) patients with this pathology [1,2]. While funding shortages make it difficult to provide services to patients who seek care, the continued stigma surrounding mental health disorders prevents many from reaching out in the first place. The confluence of

Methods

We performed a systematic search of PubMed, PsycINFO, and MEDLINE, databases for articles published from database from January 1, 1987, to June 30, 2023. We used the key words “aggression*,” “violence*,” “emergency,” “psychiatric,” “score,” and “scale,” using Boolean operators (AND, OR) for effective term combinations.

We screened abstracts for the following inclusion criteria: published in English, focus on psychiatric population and performed in an adult acute or emergency settings. We

Results

Of the 23 studies that met the inclusion criteria. These studies discussed 10 scores/scales. The included scores are presented in Table 1. The most common study methodology, occurring in seven studies of 46,993 patients, was prospective observational in nature, and two other studies performed retrospective evaluations.

The details of the individual studies are presented below.

Discussion

Overall, we identified 10 assessment tools for the objective evaluation of potential violence in an acute setting. These studies vary in terms of patient population, methodology, objectives, and statistical rigor. Of these, eight were ED-based studies, with only three studies enrolling >1000 patients. Of the ED-based studies, only three evaluated the predictive capability of a score and performed appropriate statistics. Finally, two studies provided clinical outcomes as a function of the score

Limitations

Our study has several limitations. By restricting the inclusion to studies conducted in an acute setting, we may have overlooked relevant factors that are applicable to the Emergency Department. Additionally, we only considered studies written in English, and it is possible that valuable scores developed in other languages may have been excluded. Furthermore, we excluded scores created to evaluate agitation in non-psychiatric patients, such as the elderly or dementia patients, which may be

Recommendations and conclusions

In a formal context, it is imperative to predict aggression and agitation among psychiatric patients in busy emergency departments. The utilization of violence risk prediction scores is crucial for decision making, but the process can be complicated. The efficacy of the scoring system can be confidently evaluated by assessing its impact in an emergency setting. This involves examining the number of physical and chemical restraints employed prior to and after the use of the score, the number of

CRediT authorship contribution statement

Heba Mesbah: Writing – original draft, Visualization, Methodology, Investigation, Formal analysis, Conceptualization. Zubaid Rafique: Writing – review & editing, Visualization, Methodology, Conceptualization. Nidal Moukaddam: Writing – review & editing, Visualization, Validation, Supervision. William Frank Peacock: Writing – review & editing, Supervision.

Declaration of competing interest

We declare no conflicts of interest.

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