Inpatient Violence Risk Assessed in Children, Teens

Psychiatrists at Cincinnati Children’s Hospital Medical Center are in the midst of a study to better assess risk of violence on inpatient units. “Nationally, we need to increase safety for staff, patients, and fellow patients on child inpatient units and reduce use of seclusion and restraint as much as possible,” reported psychiatrist Douglas Mossman, M.D., at the American Academy of Psychiatry and the Law’s annual meeting Thursday in Montreal.

So Mossman and colleagues Thomas Blom, M.S., and Drew Barzman, M.D., developed an assessment tool—the Brief Rating of Aggression by Children and Adolescents (BRACHA). They streamlined 67 items that predicted violence to a more manageable 14-item list, with items ranging from previous psychiatric diagnoses to impulsivity to lack of remorse, among others. Their initial work led to the current validation study covering 2,552 patients with a mean age of 13.4 admitted to the hospital for at least two days. The BRACHA was administered in the Emergency Department prior to admission. Outcomes were measured by unit nurses using the Overt Aggression Scale.

Age mattered in the predictive power of the BRACHA, said Mossman. “In children under 7 years, only being a boy was predictive,” he said, “Among 7- to  13-year-olds, most items gained predictive power, and in 13- to 19-year-olds, all items were useful in predicting future violence.” The BRACHA, said Mossman, “differentiated between high-risk (35 percent aggressive) and low-risk (8 percent) subgroups.” Their next step is to undertake a prospective validation study and determine the optimum weightings of BRACHA’s items.

For information on assessing violence in adult patients, see a report in Psychiatric Services in Advance.  

(image: Jaren Jai Wicklund/Shutterstock.com)