Scale for the Evaluation of Risk of Aggressiveness in Psychiatric Intensive Care Units

Abstract

Introduction. The multifactorial origin of violent behaviors generates the need to use prediction tools adapted to different contexts, patient profiles and types of aggression. The main objective of this work was to design an instrument to detect the risk of violence and aggression quickly and effectively in patients with mental disorder in psychiatric intensive care units.

Material and methods. The sample consisted of 722 admissions of 629 patients from the psychiatric intensive care units. Violent incidents were recorded using the Overt Aggression Scale (OAS). A new scale has been designed and its psychometric properties have been evaluated.

Results. The Scale for the Evaluation of Risk of Aggressiveness (ERA) includes static and dynamic risk factors, has an AUC=0.854, a sensitivity of 82%, a specificity of 73%, a positive predictive value of 62% and a negative predictive value of 88% when the cut-off point of ¾ is used to determine the risk of violent or aggressive behavior.

Conclusions. The ERA has proven to be a valid and reliable instrument to forecast the risk of aggressiveness in patients admitted to an acute care unit of psychiatry. It also allows monitoring and updating this risk during the patient’s stay in the psychiatric intensive care unit.