Predicting aggressive behavior in psychiatric patients in emergency department: A systematic literature review - 28/05/24

Doi : 10.1016/j.ajem.2024.02.040

Heba Mesbah ^a,^{^⁎} , Zubaid Rafique ^a, Nidal Moukaddam ^b, William Frank Peacock ^a
^a Emergency Medicine Department, Baylor College of Medicine, Houston, TX, USA
^b Baylor College of Medicine, Psychiatry, and Behavioral Sciences, Houston, TX, USA

^⁎Corresponding author.

Abstract

Introduction

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.

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Keywords : Aggression, Emergency, Scale, Score, Psychiatric