Department of Psychiatry, University of Oxford, Oxford, UK.
Consultant Forensic Psychiatrist, Barnet Enfield and Haringey Mental Health NHS Trust, UK.
Eur Psychiatry. 2018 Aug;52:47-53. doi: 10.1016/j.eurpsy.2018.02.007. Epub 2018 Apr 4.
Violent behaviour by forensic psychiatric inpatients is common. We aimed to systematically review the performance of structured risk assessment tools for violence in these settings.
The nine most commonly used violence risk assessment instruments used in psychiatric hospitals were examined. A systematic search of five databases (CINAHL, Embase, Global Health, PsycINFO and PubMed) was conducted to identify studies examining the predictive accuracy of these tools in forensic psychiatric inpatient settings. Risk assessment instruments were separated into those designed for imminent (within 24 hours) violence prediction and those designed for longer-term prediction. A range of accuracy measures and descriptive variables were extracted. A quality assessment was performed for each eligible study using the QUADAS-2. Summary performance measures (sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, and area under the curve value) and HSROC curves were produced. In addition, meta-regression analyses investigated study and sample effects on tool performance.
Fifty-two eligible publications were identified, of which 43 provided information on tool accuracy in the form of AUC statistics. These provided data on 78 individual samples, with information on 6,840 patients. Of these, 35 samples (3,306 patients from 19 publications) provided data on all performance measures. The median AUC value for the wider group of 78 samples was higher for imminent tools (AUC 0.83; IQR: 0.71-0.85) compared with longer-term tools (AUC 0.68; IQR: 0.62-0.75). Other performance measures indicated variable accuracy for imminent and longer-term tools. Meta-regression indicated that no study or sample-related characteristics were associated with between-study differences in AUCs.
The performance of current tools in predicting risk of violence beyond the first few days is variable, and the selection of which tool to use in clinical practice should consider accuracy estimates. For more imminent violence, however, there is evidence in support of brief scalable assessment tools.
法医精神病院的住院患者暴力行为很常见。我们旨在系统地回顾这些环境中用于暴力的结构化风险评估工具的性能。
检查了精神病院使用的九种最常用的暴力风险评估工具。对五个数据库（CINAHL、Embase、全球卫生、PsycINFO 和 PubMed）进行了系统搜索，以确定研究这些工具在法医精神病院住院患者环境中的预测准确性的研究。风险评估工具分为旨在预测近期（24 小时内）暴力和旨在预测长期暴力的工具。提取了一系列准确性测量值和描述性变量。使用 QUADAS-2 对每项合格研究进行质量评估。生成了汇总性能指标（敏感性、特异性、阳性和阴性预测值、诊断优势比和曲线下面积值）和 HSROC 曲线。此外，元回归分析研究了研究和样本对工具性能的影响。
确定了 52 篇合格的出版物，其中 43 篇以 AUC 统计数据的形式提供了工具准确性的信息。这些出版物提供了 78 个独立样本的数据，涉及 6840 名患者。其中，35 个样本（来自 19 篇出版物的 3306 名患者）提供了所有性能指标的数据。78 个样本的更广泛组的中位数 AUC 值更高，用于即时工具（AUC 0.83；IQR：0.71-0.85）与长期工具（AUC 0.68；IQR：0.62-0.75）相比。其他性能指标表明，即时和长期工具的准确性存在差异。元回归表明，研究或样本相关特征与 AUC 之间的差异无关。
目前用于预测暴力风险超过最初几天的工具的性能存在差异，在临床实践中选择使用哪种工具应考虑准确性估计。然而，对于更紧急的暴力，有证据支持简短的可扩展评估工具。
