Use of the Dynamic Appraisal of Situational Aggression Tool to Predict Violence in the Emergency Department and Other Acute Care Settings.

Introduction: Few violence risk assessment instruments have been validated for use among the general population in the emergency department or subsequent acute care settings. This study evaluated the predictive validity of the Dynamic Appraisal of Situational Aggression tool for use with the general population in these settings.

Method: The Dynamic Appraisal of Situational Aggression was implemented for all emergency department and acute care admissions within a large health care system in North Carolina in July 2022. A retrospective analysis was conducted with all encounters with individuals aged 18 years or older who were discharged from March 1, 2023 to May 31, 2023. Area under the curve scores from a receiver operating characteristic curve were used to assess the validity of the Dynamic Appraisal of Situational Aggression in predicting the risk of future aggressive incidents.

Results: A total of 91,951 encounters were included for analysis, of which 90.57% initially presented to the emergency department. The area under the curve of the Dynamic Appraisal of Situational Aggression in predicting an aggressive incident was .63.

Discussion: The Dynamic Appraisal of Situational Aggression had moderate predictive validity for future incidents of violence when used for the general population in the emergency department and other acute care settings. Future research might assess whether reduced clinical variation may increase the validity of the Dynamic Appraisal of Situational Aggression for these settings. Presently, hospitals should consider alternative tools for reducing the incidence of violence in the emergency department.