Short-term prediction of threatening and violent behaviour in an Acute Psychiatric Intensive Care Unit based on patient and environment characteristics

Arne E Vaaler,John C Fløvig,Valentina C Iversen,Tom Palmstierna,Olav M Linaker,Gunnar Morken

doi:10.1186/1471-244x-11-44

Abstract

BackgroundThe aims of the present study were to investigate clinically relevant patient and environment-related predictive factors for threats and violent incidents the first three days in a PICU population based on evaluations done at admittance.MethodsIn 2000 and 2001 all 118 consecutive patients were assessed at admittance to a Psychiatric Intensive Care Unit (PICU). Patient-related conditions as actuarial data from present admission, global clinical evaluations by physician at admittance and clinical nurses first day, a single rating with an observer rated scale scoring behaviours that predict short-term violence in psychiatric inpatients (The Brøset Violence Checklist (BVC)) at admittance, and environment-related conditions as use of segregation or not were related to the outcome measure Staff Observation Aggression Scale-Revised (SOAS-R). A multiple logistic regression analysis with SOAS-R as outcome variable was performed.ResultsThe global clinical evaluations and the BVC were effective and more suitable than actuarial data in predicting short-term aggression. The use of segregation reduced the number of SOAS-R incidents.ConclusionsIn a naturalistic group of patients in a PICU segregation of patients lowers the number of aggressive and threatening incidents. Prediction should be based on clinical global judgment, and instruments designed to predict short-term aggression in psychiatric inpatients.Trial registrationsNCT00184119/NCT00184132

Highlights

The aims of the present study were to investigate clinically relevant patient and environment-related predictive factors for threats and violent incidents the first three days in a Psychiatric Intensive Care Unit (PICU) population based on evaluations done at admittance
The patients admitted to PICU due to “control of behaviour” had a mean need for stay = 3 (3; indicating probable need for segregation and 4; absolute need for segregation)
The first three days a total of 3 and 19 (RR 5.72, p < 0.01(Poisson distribution), 95% CI: 1.69-19.33) violent or threatening incidents were recorded among 3 and 10 patients (11%) (RR 3.01, ns (p = 0.08) (Fischer’s exact test), 95% CI: 0.81-20.10)

Summary

Introduction

The aims of the present study were to investigate clinically relevant patient and environment-related predictive factors for threats and violent incidents the first three days in a PICU population based on evaluations done at admittance. Threatening and violent behaviour by psychiatric inpatients are major concerns in psychiatric practice [1,2]. Aggression has negative consequences for patients and staff. Some studies indicate an increasing frequency [3,4]. Reduction of severity and incidence of threatening and violent incidents are important in order to improve quality of care in psychiatric facilities. Prediction of violence is important in order to initiate preventive measures.

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Conclusion