Scale for the Evaluation of Risk of Aggressiveness in Psychiatric Intensive Care Units.

INTRODUCTION: The multifactorial origin of violent behaviors generates the need to use prediction tools adapted to different contexts, patient profiles and types of aggression. The main objective of this work was to design an instrument to detect the risk of violence and aggression quickly and effectively in patients with mental disorder in psychiatric intensive care units. MATERIAL AND METHODS: The sample consisted of 722 admissions of 629 patients from the psychiatric intensive care units. Violent incidents were recorded using the Overt Aggression Scale (OAS). A new scale has been designed and its psychometric properties have been evaluated. RESULTS: The Scale for the Evaluation of Risk of Aggressiveness (ERA) includes static and dynamic risk factors, has an AUC=0.854, a sensitivity of 82%, a specificity of 73%, a positive predictive value of 62% and a negative predictive value of 88% when the cut-off point of ¾ is used to determine the risk of violent or aggressive behavior. CONCLUSIONS: The ERA has proven to be a valid and reliable instrument to forecast the risk of aggressiveness in patients admitted to an acute care unit of psychiatry. It also allows monitoring and updating this risk during the patient's stay in the psychiatric intensive care unit.

Escala para la Evaluación del Riesgo de Agresividad en una Unidad de Agudos de Psiquatría / Scale for the Evaluation of Risk of Aggressiveness in Psychiatric Intensive Care Units

INTRODUCCIÓN: El origen multifactorial de la agresividad y la violencia genera la necesidad de utilizar instrumentos de predicción adaptados a diferentes contextos, perfiles de pacientes y tipos de agresividad. El principal objetivo de este trabajo fue diseñar un instrumento para detectar el riesgo de violencia y agresividad de forma rápida y eficaz en pacientes con trastorno mental en unidades de agudos de psiquiatría. MATERIAL Y MÉTODOS: La muestra consistió en 722 ingresos de 629 pacientes de la Unidad de Agudos. Los incidentes de violencia y agresividad fueron registrados usando la Overt Aggression Scale (OAS). Se ha diseñado una nueva escala y se han evaluado sus propiedades psicométricas. RESULTADOS: La Escala para la Evaluación del Riesgo de Agresividad (ERA) incluye factores de riesgo estáticos y dinámicos, tiene un AUC=0.854, una sensibilidad del 82%, una especificidad del 73%, un valor predictivo positivo del 62% y un valor predictivo negativo de 88% cuando se utiliza el punto de corte ¾ para determinar el riesgo de comportamiento violento o agresivo. CONCLUSIONES: La ERA ha demostrado ser un instrumento válido y fiable, eficaz para predecir el riesgo de agresividad en los pacientes ingresados en una unidad de agudos de psiquiatría. También permite hacer un seguimiento y actualizar este riesgo durante la estancia del paciente en la unidad de agudos

INTRODUCTION: The multifactorial origin of violent behaviors generates the need to use prediction tools adapted to different contexts, patient profiles and types of aggression. The main objective of this work was to design an instrument to detect the risk of violence and aggression quickly and effectively in patients with mental disorder in psychiatric intensive care units. MATERIAL AND METHODS: The sample consisted of 722 admissions of 629 patients from the psychiatric intensive care units. Violent incidents were recorded using the Overt Ag-gression Scale (OAS). A new scale has been designed and its psychometric properties have been evaluated. RESULTS: The Scale for the Evaluation of Risk of Aggressiveness (ERA) includes static and dynamic risk factors, has an AUC=0.854, a sensitivity of 82%, a specificity of 73%, a positive predictive value of 62% and a negative predictive value of 88% when the cut-off point of ¾ is used to determine the risk of violent or aggressive behavior. CONCLUSIONS: The ERA has proven to be a valid and reliable instrument to forecast the risk of aggressiveness in patients admitted to an acute care unit of psychiatry. It also allows monitoring and updating this risk during the patient's stay in the psychiatric intensive care unit