Evaluating the Predictive Validity of the Fordham Risk Screening Tool (FRST) for Violent Behavior during Inpatient...

Area of Science:

• Psychiatry
• Criminology
• Public Health

Background:

• Prior research indicates the Fordham Risk Screening Tool (FRST) is accurate for assessing violence risk compared to comprehensive instruments.
• A gap exists in the literature linking violence risk screening tools to actual markers of violent behavior.
• This study addresses the need to validate the FRST's ability to predict violence markers in psychiatric inpatients.

Purpose of the Study:

• To determine if the FRST can accurately assess the likelihood of violence and its markers during inpatient psychiatric admissions.
• To evaluate the predictive validity and reliability of the FRST in a real-world clinical setting.

Main Methods:

• A retrospective survey of health records from 423 adult psychiatric inpatients admitted from the emergency department.
• Data abstraction included FRST screening results from the ED and markers of violent behavior during hospitalization.
• Statistical analysis compared violent incidents between FRST-positive and FRST-negative groups.

Main Results:

• A significantly greater proportion of FRST-positive patients experienced violent incidents (33.0%) compared to FRST-negative patients (8.1%) (p < 0.001).
• Sensitivity was 33.0%, specificity was 91.9%, positive predictive value was 60.3%, and negative predictive value was 78.6%.
• The area under the receiver operating characteristic curve (AUROC) was 0.305, indicating limited predictive ability.

Conclusions:

• The FRST demonstrated mixed results in predicting violent behavior among psychiatric inpatients.
• While significant differences in violence were observed, the tool's predictive validity and reliability metrics were limited.
• The FRST should be used in conjunction with other methods for comprehensive inpatient violence risk assessment.