Predicting inpatient violence using an extended version of the Brøset-Violence-Checklist: instrument development and clinical application.
BACKGROUND
Patient aggression is a common problem in acute psychiatric wards and calls for preventive measures. The timely use of preventive measures presupposes a preceded risk assessment. The Norwegian Brøset-Violence-Checklist (BVC) is one of the few instruments suited for short-time prediction of violence of psychiatric inpatients in routine care. Aims of our study were to improve the accuracy of the short-term prediction of violence in acute inpatient settings by combining the Brøset-Violence-Checklist (BVC) with an overall subjective clinical risk-assessment and to test the application of the combined measure in daily practice.


METHODS
We conducted a prospective cohort study with two samples of newly admitted psychiatric patients for instrument development (219 patients) and clinical application (300 patients). Risk of physical attacks was assessed by combining the 6-item BVC and a 6-point score derived from a Visual Analog Scale. Incidents were registered with the Staff Observation of Aggression Scale-Revised SOAS-R. Test accuracy was described as the area under the receiver operating characteristic curve (AUCROC).


RESULTS
The AUCROC of the new VAS-complemented BVC-version (BVC-VAS) was 0.95 in and 0.89 in the derivation and validation study respectively.


CONCLUSIONS
The BVC-VAS is an easy to use and accurate instrument for systematic short-term prediction of violent attacks in acute psychiatric wards. The inclusion of the VAS-derived data did not change the accuracy of the original BVC.
Abderhalden
Christoph
C
Nursing and Social Education Research Unit, University Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland. abderhalden@puk.unibe.ch
Needham
Ian
I
Dassen
Theo
T
Halfens
Ruud
R
Haug
Hans-Joachim
HJ
Fischer
Joachim
J
D000208:Acute Disease; D000328:Adult; D000374:Aggression / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011568:Psychiatric Nursing; D011594:Psychometrics; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D011795:Surveys and Questionnaires; D013557:Switzerland; D014754:Violence / Q000517:prevention & control / Q000523:psychology*