Abstract
Poster presentation
SessionA presented Monday, September 30, 10:00-11:00 am
Purpose: The Dynamic Appraisal for Situational Aggression (DASA) is a screening tool developed to predict violent or aggressive behavior by Behavioral Health (BH) patients. It has been validated for use in both inpatient psychiatric units and forensic health units. It was implemented in our Emergency Department (ED) in April 2018, and a study was conducted to determine its validity in the ED context.
Design: The study was conducted as a prospective cohort study.
Setting: The study was conducted at a teaching, urban level I trauma center with affiliated psychiatric hospital on-site.
Participants/Subjects: Patients included in the study were adult patients evaluated in the ED for BH complaints, for whom at least one DASA assessment was documented in the electronic health record (EHR). Patients were excluded if they had a privacy request attached to their EHR.
Methods: Medical records with a documented DASA assessment were extracted from the EHR. Outcomes measured were the incidence of an act of violence or aggression, defined as placement of hard leather restraints or administration of emergency sedative medication intramuscularly. AUC curves will be generated to determine if a particular score on the DASA is associated with an increased incidence of violent or aggressive behavior. In the case that an association is observed, time-to-event will be reported.
Results/Outcomes: Increased DASA scores were associated with a consistent increase in risk of violent or aggressive behavior. The AUC of the ROC using all documented aggressions was 0.794, indicating that the probability that a patient who became violent or aggressive had a 79.4% probability of having a higher DASA score than a patient who did not display violence or aggression while in the ED.
Implications: If validated, the DASA could be a useful tool to improve the treatment of BH patients through a reduction in use of physical restraint and chemical sedation. A validated tool capable of predicting violence or aggression in patients could also diminish the incidence of violence against ED staff members. If the study is unable to determine validity for using the DASA in an ED context, the results are important to report as ED leadership nationwide continues to seek resources that may improve the care provided to BH patients and reduce violence against their staff.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Behavioral Health, Leadership and Management, Research
Recommended Citation
Connor, Melissa; Doering, Lynn V.; Lee, Eunice; and Chen, Belinda, "Validation of the dynamic appraisal for situational aggression" (2020). General Submissions: Presenations (Oral and Poster). 149.
https://www.sigmarepository.org/gen_sub_presentations/2019/posters/149
Conference Name
Emergency Nursing 2019
Conference Host
Emergency Nurses Association
Conference Location
Austin, Texas, USA
Conference Year
2019
Rights Holder
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Validation of the dynamic appraisal for situational aggression
Austin, Texas, USA
Poster presentation
SessionA presented Monday, September 30, 10:00-11:00 am
Purpose: The Dynamic Appraisal for Situational Aggression (DASA) is a screening tool developed to predict violent or aggressive behavior by Behavioral Health (BH) patients. It has been validated for use in both inpatient psychiatric units and forensic health units. It was implemented in our Emergency Department (ED) in April 2018, and a study was conducted to determine its validity in the ED context.
Design: The study was conducted as a prospective cohort study.
Setting: The study was conducted at a teaching, urban level I trauma center with affiliated psychiatric hospital on-site.
Participants/Subjects: Patients included in the study were adult patients evaluated in the ED for BH complaints, for whom at least one DASA assessment was documented in the electronic health record (EHR). Patients were excluded if they had a privacy request attached to their EHR.
Methods: Medical records with a documented DASA assessment were extracted from the EHR. Outcomes measured were the incidence of an act of violence or aggression, defined as placement of hard leather restraints or administration of emergency sedative medication intramuscularly. AUC curves will be generated to determine if a particular score on the DASA is associated with an increased incidence of violent or aggressive behavior. In the case that an association is observed, time-to-event will be reported.
Results/Outcomes: Increased DASA scores were associated with a consistent increase in risk of violent or aggressive behavior. The AUC of the ROC using all documented aggressions was 0.794, indicating that the probability that a patient who became violent or aggressive had a 79.4% probability of having a higher DASA score than a patient who did not display violence or aggression while in the ED.
Implications: If validated, the DASA could be a useful tool to improve the treatment of BH patients through a reduction in use of physical restraint and chemical sedation. A validated tool capable of predicting violence or aggression in patients could also diminish the incidence of violence against ED staff members. If the study is unable to determine validity for using the DASA in an ED context, the results are important to report as ED leadership nationwide continues to seek resources that may improve the care provided to BH patients and reduce violence against their staff.