Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments.

Area of Science:

• Emergency Medicine
• Patient Safety
• Clinical Assessment Tools

Background:

• Violence is a significant, preventable issue in emergency departments (EDs).
• Validated screening tools are crucial for identifying patients at risk of violent behavior.
• Existing methods may not adequately address the need for rapid risk assessment in ED settings.

Purpose of the Study:

• To evaluate the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening potentially violent patients in the ED.
• To adapt and validate the ABRAT for use by triage nurses within electronic health records (EHRs).
• To identify key indicators predictive of aggressive behavior in an emergency department population.

Main Methods:

• A prospective cohort study involving 10,554 adult and pediatric patients across three Michigan EDs.
• Triage nurses utilized a 16-item ABRAT checklist integrated into EHRs.
• Multivariate logistic regression and receiver operating characteristic (ROC) analysis were employed to refine the tool and assess its performance.

Main Results:

• The refined 7-item ABRAT demonstrated high accuracy, with an area under the curve (AUC) of 0.91.
• At an optimal cutoff score of 1, the ABRAT achieved 84.3% sensitivity and 95.3% specificity.
• An alternative cutoff score of 4 yielded 70.1% sensitivity and 98.9% specificity for high-risk identification.

Conclusions:

• The ABRAT for EDs is a simple, comprehensive tool with high sensitivity and specificity for identifying potentially violent patients.
• Integration into EHR systems facilitates rapid identification of at-risk individuals.
• The tool supports the implementation of targeted mitigation strategies to enhance safety for emergency department staff and patients.