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New aggression tool predicts violent patients on the wards
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20th October 2011
AUK Staff
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 ...the 10-point Aggressive Behaviour Risk Assessment Tool ... appears to provide a promising tool for predicting which patients will become violent during their hospital stay
 Professor Son Chae Kim
Using a specially designed risk assessment tool was an effective way of identifying violent hospital patients in medical and surgical units, according to a study in the November issue of the Journal of Advanced Nursing.

American researchers led by Son Chae Kim, Professor of Nursing at Point Loma Nazarene University and Kristyn Ideker, a Registered Nurse at Scripps Memorial Hospital, San Diego, California, studied more than 2,000 patients admitted to an American acute care hospital over a 5-month period.

“Patient violence occurs in all healthcare settings and, although a number of tools have been developed for use in psychiatric units, there is a lack of brief screening tools for medical and surgical settings”, said Professor Kim.

“That is why we developed the 10-point Aggressive Behaviour Risk Assessment Tool (ABRAT), which was completed within 24 hours of admission and appears to provide a promising tool for predicting which patients will become violent during their hospital stay.

“For example less than 1% of patients with an ABRAT rating of zero became violent, compared with 41% of those with a rating of two or more.

“Two nurses completed an ABRAT rating for each patient, agreeing in 93% and 96.5% of cases on ABRAT scores with cut off points of one and two respectively.”

Key findings of the study included:

  • Fifty-six of the 2,063 patients (3%) were involved in one or more of the violent incidents. These included 35 episodes of verbal abuse, 26 physical attacks, 15 threats of physical attack, 12 incidents where an emergency call went out to security personnel and three cases of sexual harassment.
  • Less than 1%of the patients with an ABRAT score of zero became violent, compared with 8% of the patients with a score of one and 41% of the patients with a score of two or more.
  • Half of the violent incidents involved patients aged over 70, despite the fact that they only made up 40% of the patients studied. Males, who made up 48% of the patients studied were almost twice as likely to become violent as females (64% versus 34%).
The researchers quantified the ability of the ABRAT to predict violence in the medical and surgical settings by using the predictive value, where 100% represents a perfect prediction.

  • The negative predictive value of an ABRAT score of zero - the proportion of subjects with negative test results who were correctly classified to represent a low risk of violence – was greater than 99%.
  • The positive predictive value of an ABRAT score of two or more – the proportion of subjects with positive test results who were correctly classified to represent a high risk of violence - was 41%.
  • The five most common predictors of violence were: confusion/cognitive impairment, anxiety, agitation, shouting/demanding and a history of physical aggression.

 Further studies are now needed to see whether the use of the ABRAT can actually reduce violence in clinical settings
 Professor Son Chae Kim
The ABRAT included a number of items from the M55 tool, previously used in general acute care. It also drew on the STAMP concept, published in the Journal of Advanced Nursing in 2007, which covers staring and eye contact, tone and volume of voice, anxiety, mumbling and pacing.

Nurses who had undergone a training course in use of the tool collected the data from patients admitted to six different medical-surgical units.

“The results from this study indicate that the ten-item ABRAT could be useful in identifying potentially violent patients in medical-surgical units, with acceptable accuracy and agreement between users” says Professor Kim.

“Further studies are now needed to see whether the use of the ABRAT can actually reduce violence in clinical settings.”


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