title: Violence in the pediatric emergency department.
abstract: OBJECTIVE
  To identify the frequency of violence and the perception of safety in pediatric emergency departments.
  
  
  METHODS
  Descriptive, cross-sectional survey of directors of pediatric EDs with fellowship programs.
  
  
  METHODS
  University-based urban pediatric EDs.
  
  
  METHODS
  Forty-seven pediatric ED directors were surveyed, with 94% responding.
  
  
  RESULTS
  More than three-fourths of those responding reported one or more verbal threats per week; 77% reported one or more physical attacks on staff per year; and 25% reported actual injury to staff. No pediatric EDs had weapon detectors; 7% had city police stationed there; and 54% had 24-hour security stationed in the pediatric ED. The majority reported that their staff members practice with at least occasional fear (55%) and had documented this concern (82%). Perception of safety was associated with the incidence of verbal threats (P < .006), physical attacks (P < .03), injury to staff or patient (P < .01), and the frequency with which security was needed (P < .001). Pediatric EDs with 50,000 or more visits per year were more likely to have multiple physical attacks on staff (relative risk, 2.89; 95% confidence interval, 1.33-6.26; P < .004). More verbal threats were reported in pediatric EDs with longer waiting times (P < .001). Fewer than half of the pediatric EDs with reported injuries had 24-hour security.
  
  
  CONCLUSIONS
  Pediatric EDs are not immune to the problem of violence. Efforts must be directed to increase safety through better security, more efficient patient care, and aggression management training.
authors.affiliation: Division of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: C M
authors.initials: CM
authors.lastname: McAneney
authors.forename: K N
authors.initials: KN
authors.lastname: Shaw
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005239:Fear; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D010372:Pediatrics / Q000706:statistics & numerical data; D008486:Physician Executives / Q000523:psychology; D012307:Risk Factors; D012449:Safety; D012637:Security Measures; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data*