Aggression, violence and threatening behaviour during critical illness.

Area of Science:

• Critical Care Medicine
• Trauma Surgery
• Patient Safety

Background:

• Patient aggression and violence pose significant challenges in critical care settings.
• Understanding the prevalence and risk factors for these events is crucial for improving patient and staff safety.

Purpose of the Study:

• To quantify the prevalence of patient aggression or threatened/actual violence (Code Grey events) during critical illness.
• To identify patient demographics, diagnoses, and illness severity associated with Code Grey events.

Main Methods:

• Retrospective cohort study of adult trauma intensive care unit (ICU) admissions between January 2015 and December 2020.
• Analysis of "Code Grey" response triggers for aggression or threatened/actual violence.
• Logistic mixed-effects modeling to determine predictors of Code Grey events.

Main Results:

• A total of 807 Code Grey events occurred in 379 (2.7%) of 16,175 ICU admissions.
• The incidence of Code Grey events increased from 2015 to 2020.
• Independent predictors included male sex, younger age (20-30 years), emergency department admission, and trauma diagnosis. Code Grey patients had longer ICU stays but a reduced risk of death.

Conclusions:

• The prevalence of Code Grey events in the ICU is increasing and may involve repeated incidents per patient.
• Younger male patients admitted from the emergency department with trauma diagnoses are at the highest risk.
• These findings highlight the need for targeted interventions to mitigate patient aggression in critical care environments.