Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments
Abstract Objective Violence is a major preventable problem in emergency departments (EDs), and validated screening tools are needed to identify potentially violent patients. We aimed to test the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening patients in the ED. Methods...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-04-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12693 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850241108330676224 |
|---|---|
| author | Son Chae Kim Jennifer Kaiser Julie Bulson Tracy Hosford Ashleigh Nurski Carol Sadat Nicole Kalinowski |
| author_facet | Son Chae Kim Jennifer Kaiser Julie Bulson Tracy Hosford Ashleigh Nurski Carol Sadat Nicole Kalinowski |
| author_sort | Son Chae Kim |
| collection | DOAJ |
| description | Abstract Objective Violence is a major preventable problem in emergency departments (EDs), and validated screening tools are needed to identify potentially violent patients. We aimed to test the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening patients in the ED. Methods A prospective cohort study was conducted among adult and pediatric patients aged ≥10 years visiting 3 emergency departments in Michigan between May 1, 2021, and June 30, 2021. Triage nurses completed the 16‐item checklist using electronic health records (EHRs), and the occurrence of violent incidents were collected before ED disposition. A multivariate logistic regression model was applied to select a parsimonious set of items. Results Among 10,554 patients, 127 had ≥1 violent incidents (1.2%). The regression model resulted in a 7‐item ABRAT for EDs, including history of aggression and mental illness and reason for visit, as well as 4 violent behavior indicators. Receiver operating characteristics analysis showed that the area under the curve was 0.91 (95% confidence interval [CI], 0.87–0.95), with a sensitivity of 84.3% (95% CI, 76.5%–89.9%) and specificity of 95.3% (95% CI, 94.8%–95.7%) at the optimal cutoff score of 1. An alternative cutoff score of 4 for identifying patients at high risk for violence had a sensitivity and specificity of 70.1% and 98.9%, respectively. Conclusion The ABRAT for EDs appears to be a simple yet comprehensive checklist with a high sensitivity and specificity for identifying potentially violent patients in EDs. The availability of such a screening checklist in the EHR may allow rapid identification of high‐risk patients and implementation of focused mitigation measures to protect emergency staff and patients. |
| format | Article |
| id | doaj-art-a554ac3e50f84ba8bc47bf75cada07fa |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2022-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-a554ac3e50f84ba8bc47bf75cada07fa2025-08-20T02:00:41ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522022-04-0132n/an/a10.1002/emp2.12693Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departmentsSon Chae Kim0Jennifer Kaiser1Julie Bulson2Tracy Hosford3Ashleigh Nurski4Carol Sadat5Nicole Kalinowski6School of Nursing Point Loma Nazarene University San Diego California USANursing Professional Practice and Development Spectrum Health Grand Rapids Michigan USABusiness Assurance Spectrum Health Grand Rapids Michigan USAEmergency Trauma Spectrum Health Grand Rapids Michigan USAEmergency Department Helen DeVos Children's Hospital Grand Rapids Michigan USAAdult Emergency Services & ED Observation Spectrum Health Grand Rapids Michigan USAEmergency Department Helen DeVos Children's Hospital Grand Rapids Michigan USAAbstract Objective Violence is a major preventable problem in emergency departments (EDs), and validated screening tools are needed to identify potentially violent patients. We aimed to test the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening patients in the ED. Methods A prospective cohort study was conducted among adult and pediatric patients aged ≥10 years visiting 3 emergency departments in Michigan between May 1, 2021, and June 30, 2021. Triage nurses completed the 16‐item checklist using electronic health records (EHRs), and the occurrence of violent incidents were collected before ED disposition. A multivariate logistic regression model was applied to select a parsimonious set of items. Results Among 10,554 patients, 127 had ≥1 violent incidents (1.2%). The regression model resulted in a 7‐item ABRAT for EDs, including history of aggression and mental illness and reason for visit, as well as 4 violent behavior indicators. Receiver operating characteristics analysis showed that the area under the curve was 0.91 (95% confidence interval [CI], 0.87–0.95), with a sensitivity of 84.3% (95% CI, 76.5%–89.9%) and specificity of 95.3% (95% CI, 94.8%–95.7%) at the optimal cutoff score of 1. An alternative cutoff score of 4 for identifying patients at high risk for violence had a sensitivity and specificity of 70.1% and 98.9%, respectively. Conclusion The ABRAT for EDs appears to be a simple yet comprehensive checklist with a high sensitivity and specificity for identifying potentially violent patients in EDs. The availability of such a screening checklist in the EHR may allow rapid identification of high‐risk patients and implementation of focused mitigation measures to protect emergency staff and patients.https://doi.org/10.1002/emp2.12693emergency departmentrisk assessmentscreeningsensitivityspecificityviolence |
| spellingShingle | Son Chae Kim Jennifer Kaiser Julie Bulson Tracy Hosford Ashleigh Nurski Carol Sadat Nicole Kalinowski Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments Journal of the American College of Emergency Physicians Open emergency department risk assessment screening sensitivity specificity violence |
| title | Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments |
| title_full | Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments |
| title_fullStr | Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments |
| title_full_unstemmed | Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments |
| title_short | Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments |
| title_sort | multisite study of aggressive behavior risk assessment tool in emergency departments |
| topic | emergency department risk assessment screening sensitivity specificity violence |
| url | https://doi.org/10.1002/emp2.12693 |
| work_keys_str_mv | AT sonchaekim multisitestudyofaggressivebehaviorriskassessmenttoolinemergencydepartments AT jenniferkaiser multisitestudyofaggressivebehaviorriskassessmenttoolinemergencydepartments AT juliebulson multisitestudyofaggressivebehaviorriskassessmenttoolinemergencydepartments AT tracyhosford multisitestudyofaggressivebehaviorriskassessmenttoolinemergencydepartments AT ashleighnurski multisitestudyofaggressivebehaviorriskassessmenttoolinemergencydepartments AT carolsadat multisitestudyofaggressivebehaviorriskassessmenttoolinemergencydepartments AT nicolekalinowski multisitestudyofaggressivebehaviorriskassessmenttoolinemergencydepartments |