Risk stratification for violent behavior in critically ill patients: Current assessment tools.

Area of Science:

• Critical Care Medicine
• Psychiatric Nursing
• Healthcare Risk Management

Background:

• Workplace violence (WPV) is a significant challenge in intensive care units (ICUs).
• Effective prediction of violent behavior in adult ICU patients is crucial for staff and patient safety.
• Existing risk assessment tools often originate from non-ICU settings.

Purpose of the Study:

• To identify and evaluate risk assessment tools for predicting violent behavior in adult ICU patients.
• To assess the performance and clinical utility of these tools in acute care settings.
• To determine the applicability of existing tools to the unique ICU environment.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar.
• Included studies focused on risk scores used in emergency departments, hospitals, and ICUs.
• Evaluated risk factors, predictive validity, and relevance of identified scores to ICU settings.

Main Results:

• 24 studies were included, with most focusing on psychiatric ICUs or emergency departments.
• Ten distinct risk scores were identified, utilizing 30 different variables.
• The Broset Violence Checklist (BVC) showed moderate accuracy in psychiatric settings but limited validation for general ICUs; overall evidence quality was low.

Conclusions:

• There is a scarcity of validated violence risk assessment tools specifically for general ICU populations.
• Existing tools, primarily developed for other settings, show limited applicability and validation in ICUs.
• Development of novel, ICU-specific violence prediction models incorporating relevant factors is urgently needed.