title: Sensitivity and specificity of the Brøset Violence Checklist as predictor of violence in forensic psychiatry.
abstract: BACKGROUND
  Violence and aggressive behavior within psychiatric facilities are serious work environment problems, which have negative consequences for both patients and staff. It is therefore of great importance to reduce both the number and the severity of these violent incidents to improve quality of care.
  
  
  OBJECTIVE
  To evaluate the specificity and sensitivity of the Brøset Violence Checklist (BVC) as a predictor of violent incidents for Danish forensic psychiatry patients.
  
  
  METHODS
  A total of 156 patients were assessed three times daily with the BVC for 24 months. All aggressive or violent incidents were recorded using the Staff Observation Aggression Scale-Revised (SOAS-R). SOAS-R scores of 9 or more defined violent incidents. Data were analyzed using standard logistic regression models as well as models incorporating a random person effect. We used receiver operating curve (ROC) analysis to evaluate different BVC thresholds.
  
  
  RESULTS
  Of a total of 139,579 BVC registrations we found 1999 scores above 0 and 419 violent incidents. The BVC score was a strong predictor of violence. For the standard cut-off point of 3, specificity was 0.997 and sensitivity was 0.656. For the general risk of violence seen in this study, the risk of violence given a BVC score > 3 (positive predictive value) was 37.2%, and the risk of violence given a BVC score < 3 (negative predictive value) was 0.1%.
  
  
  CONCLUSIONS
  The BVC showed satisfactory specificity and sensitivity as a predictor of the short-term risk of violence against staff and others by patients in a forensic setting.
authors: Jacob Hvidhjelm, Forensic Psychiatry Department, Mental Health Center Sct. Hans , Roskilde , Denmark .
authors: Jacob
authors: J
authors: Hvidhjelm
authors: Dorte
authors: D
authors: Sestoft
authors: Lene Theil
authors: LT
authors: Skovgaard
authors: Jakob
authors: J
authors: Bue Bjorner
mesh_terms: D000328:Adult; D000368:Aged; D057189:Checklist / Q000592:standards; D005260:Female; D005555:Forensic Psychiatry / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011567:Psychiatric Department, Hospital; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012306:Risk; D012680:Sensitivity and Specificity; D013997:Time Factors; D014754:Violence / Q000706:statistics & numerical data*
keywords: Aggression; Forensic psychiatry; Risk management; Short-term risk assessment; Violence