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Triage Use of the Dynamic Appraisal of Situational Aggression Score in Pediatric Emergency Care

Amy D Costigan1, Theodore E Macnow2, Martin A Reznek1

  • 1Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.

Pediatric Emergency Care
|January 30, 2026
PubMed

Insights

The Dynamic Appraisal of Situational Aggression (DASA) tool effectively predicts aggressive behavior in pediatric emergency departments. Higher DASA scores correlate with increased use of safety medications and physical restraints for children.

Area of Science:

  • Pediatric Emergency Medicine
  • Behavioral Health
  • Clinical Safety

Background:

  • Aggressive behavior in pediatric emergency departments (EDs) poses significant safety risks.
  • Limited tools exist to identify children at risk for aggression in ED settings.
  • Evaluating predictive tools is crucial for improving patient and staff safety.

Purpose of the Study:

  • To assess the association between Dynamic Appraisal of Situational Aggression (DASA) scores and the utilization of safety medications or physical restraints in pediatric ED encounters.
  • To determine if DASA scores can predict the need for behavioral interventions in pediatric patients.
  • To validate DASA as an aggression prediction tool across different age groups.

Main Methods:

  • A cross-sectional study involving 17,482 pediatric patients (ages 5-17) across 5 EDs.
  • Patients were assigned DASA scores at triage, categorizing them into low, moderate, high, or imminent risk levels.
  • Modified Poisson regression was used to estimate adjusted prevalence ratios for behavioral interventions (physical restraint or safety medications).

Main Results:

  • Higher DASA scores were strongly associated with increased use of behavioral interventions.
  • Pediatric patients with imminent-risk DASA scores showed an 11.45-fold increased likelihood of receiving any intervention compared to low-risk patients.
  • Imminent-risk scores were associated with a 46.67-fold increase in physical restraint use and an 11.30-fold increase in medication administration.

Conclusions:

  • Elevated DASA scores at ED triage are significantly associated with higher rates of behavioral interventions in pediatric patients.
  • The DASA tool demonstrates value in predicting aggression risk in both pediatric and adult populations.
  • Further research is warranted to explore proactive, DASA-guided interventions to mitigate aggression risk in pediatric EDs.
Abstract

Keywords:
aggressiondynamic appraisal of situational aggressionrisk assessmentworkplace violence

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