Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression to Predict Violence and Aggression by Behavioral Health Patients in the Emergency Department

Abstract

Introduction: The Dynamic Appraisal of Situational Aggression (DASA) is an assessment tool that has been validated to predict violent or aggressive behavior in psychiatric inpatient settings. Its validity has not been established for use in the emergency department.

Methods: The DASA was implemented within the electronic health record of an academic medical center with inpatient psychiatric services. A retrospective analysis was conducted using Spearman rank-correlation coefficients to compare a final risk score with the subsequent occurrence of violence or aggression, defined as the use of hard leather physical restraints or the administration of intramuscular sedative medication. A receiver operating characteristic curve was used to summarize the predictive accuracy of the tool to assess aggression in behavioral health patients in the emergency department.

Results: A total of 3,433 scores were analyzed, representing 1,548 patients. The DASA had predictive validity with increasing scores comparing all tested cutoff scores against incidence of violence and aggression. The area under the curve comparing scores of 0 versus more than 0 was 0.79. The median time to subsequent aggression was 110 minutes.

Discussion: The DASA has predictive validity for use in evaluating behavioral health patients in the ED setting in an urban academic medical center. The tool is capable of predicting violence or aggression within a time frame conducive to the implementation of noninvasive measures. The DASA should be tested in other ED settings to further establish its predictive validity.

Keywords: Assessment tools; DASA; Emergency; Predict; Violence.