Developing a Tool for Assessing Risk of Inpatients’ Aggressive Behavior

Journal of the American Academy of Psychiatry and the Law

This study assessed the Brief Rating of Aggression by Children and Adolescents (BRACHA) tool to test whether it was helpful in predicting which adolescent psychiatric patients might be aggressive toward hospital staff or their physicians. The study involved administering the BRACHA questionnaire – consisting of 16 questions along with various demographic data – to 418 children and teenagers during the admissions process for the psychiatric units at Cincinnati Children’s Hospital.

Hospital personnel then recorded any incident of aggression that occurred during the patient’s first six days of hospitalization.  The period was limited to six days to make the analyses consistent.  Overall, a total of 292 aggressive acts were committed by 120 hospitalized patients (29 percent). Of the 292 incidents, 102 were verbal, 81 were toward objects, 63 were toward others, and 46 were toward self.

The study confirmed that 14 of the 16 questions on the survey were significantly associated with aggression by children and teenagers.

Study results found that the BRACHA tool can help emergency department clinicians rapidly categorize children and adolescents into groups with distinctly higher or lower risks for aggression and violence while hospitalized.  This study is believed to be the first to find that a younger age is often associated with higher risk levels for inpatient violence and aggression.

In addition, the BRACHA might be able to help doctors improve hospital safety, reduce the use of restraint and seclusion in the inpatient environment and focus interventions on reducing aggressive-related behavioral risks.

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