Violence in the pediatric emergency department

To identify the frequency of violence and the perception of safety in pediatric emergency departments.

Descriptive, cross-sectional survey of directors of pediatric EDs with fellowship programs.

University-based urban pediatric EDs.

Forty-seven pediatric ED directors were surveyed, with 94% responding.

More than three-fourths of those responding reported one or more verbal threats per week; 77% reported one or more physical attacks on staff per year; and 25% reported actual injury to staff. No pediatric EDs had weapon detectors; 7% had city police stationed there; and 54% had 24-hour security stationed in the pediatric ED. The majority reported that their staff members practice with at least occasional fear (55%) and had documented this concern (82%). Perception of safety was associated with the incidence of verbal threats (P < .006), physical attacks (P < .03), injury to staff or patient (P < .01), and the frequency with which security was needed (P < .001). Pediatric EDs with 50,000 or more visits per year were more likely to have multiple physical attacks on staff (relative risk, 2.89; 95% confidence interval, 1.33-6.26; P < .004). More verbal threats were reported in pediatric EDs with longer waiting times (P < .001). Fewer than half of the pediatric EDs with reported injuries had 24-hour security.

Pediatric EDs are not immune to the problem of violence. Efforts must be directed to increase safety through better security, more efficient patient care, and aggression management training.