Early Identification of Aggression Risk in Hospitalized Adults: Evaluating the Dynamic Appraisal of Situational...

As violence toward healthcare personnel escalates worldwide, nurses seek methods to identify patients at risk for aggression before harm occurs. Multiple assessment guides for aggression risk are available for psychiatric patients. However, few assessment tools have been tested with patients hospitalized in non-psychiatric settings. This observational study examined the reliability and validity of the Dynamic Appraisal for Situational Aggression (DASA) tool in hospitalized adults. Data extracted from electronic health records of inpatients in one hospital in 2024 included baseline DASA assessments and aggressive acts within 12-24 h post-baseline. The convenience sample (n = 1,347) was predominantly older Caucasian adults. Nurses (n = 80) tested inter-rater reliability in 40 inpatients. An intraclass correlation coefficient of 0.93 for the overall score and Kappa scores of 0.56-1.00 for the items indicated nurses used the DASA consistently. Patients categorized as high risk demonstrated nearly 18 times more aggressive acts compared to low-risk patients (16.0% vs. 0.9%). Furthermore, patients categorized as moderate or high risk demonstrated a greater likelihood of aggression 12-24 h post-baseline compared with low-risk patients (2.9% and 16.0% vs. 0.9%, respectively). DASA risk category was significantly associated with aggressive acts 12-24 h post-baseline (Fisher-Freeman-Halton Exact Test = 19.11, p < 0.001). Results offer early support for the reliability and validity of the DASA in a new clinical population. Further testing in diverse settings with greater numbers of aggressive events may provide additional evidence for the usefulness of the DASA in the early identification of inpatients at risk for aggression.