Aggression, violence and threatening behaviour during critical illness

Abstract

ObjectiveThis article aims to quantify prevalence of patient aggression or threatened/actual violence during critical illness. DesignThis is a retrospective cohort study. SettingThis study was conducted in single adult trauma intensive care unit (ICU). ParticipantsPatients aged 18 years or over, admitted between January 2015 and December 2020, who triggered a “Code Grey” response due to aggression or threatened/actual violence. Main outcome measureThe primary outcome was prevalence of Code Grey events. Secondary outcomes included unadjusted and adjusted (logistic mixed model) effects of patient demographics, diagnoses and severity of illness on Code Grey events. ResultsThere were 16175 ICU admissions relating to 14085 patients and 807 Code Grey events involving 379 (2.7%) patients. The observed count of events increased progressively from 2015 (n = 77) to 2020 (n = 204). For patients with a Code Grey, the median count of events was 3 (range 1–33). Independent predictors of at least one ICU Code Grey event included male sex (OR 2.5; 95% CI 1.8 to 3.4), young age (most elevated odds ratio in patients 20–30 years), admission from the emergency department (OR 2.8, 95% CI 2.1 to 3.6) and a trauma diagnosis (OR 1.4, 95% CI 1.1 to 1.9). Code Grey patients had longer admissions with a reduced risk of death. ConclusionsThe prevalence of Code Grey events in ICU appears to be increasing. Patients may have repeated events. Younger male patients admitted to ICU via the emergency department with a trauma or medical diagnosis are at greatest risk of a Code Grey event.