Kim Son Chae, Vejnovich Chris, Hall Lyndsi, Rawlings Melinda, Thompson Karissa
School of Nursing, Point Loma Nazarene University, San Diego, California, USA.
Nebraska Methodist Hospital, Omaha, Nebraska, USA.
J Adv Nurs. 2025 May;81(5):2393-2401. doi: 10.1111/jan.16418. Epub 2024 Oct 7.
To refine and validate an electronic version of the Aggressive Behaviour Risk Assessment Tool (ABRAT) and determine the sensitivity and specificity for identifying potentially violent patients in non-psychiatric inpatient units.
A prospective cohort study design was used.
All patients admitted or transferred to three inpatient units of an acute care hospital in Nebraska, USA, from 7 February to 9 April 2023, were included. The 10-item ABRAT assessments were performed daily for the first 3 days of admission. The violent events were collected until discharge in three categories: Physical aggression towards others, physical aggression towards property and verbal intimidation/threat towards others. Kendall's tau tests and a multivariate logistic regression procedure were performed to select a parsimonious set of items that best predict violent events.
Of 1179 patients, 69 had ≥1 violent event (5.9%). The revised six-item tool with item weighting was named ABRAT for Hospitalised Patients (ABRAT-H). The area under the curve from the Receiver Operating Characteristics analysis was 0.82. The sensitivity and specificity at a cutoff score of two were 68.1% and 85.2%, respectively. As ABRAT-H scores increased, the percentage of violent patients also increased and for patients with scores ≥5, 55.2% became violent.
ABRAT-H appears to be useful for identifying potentially violent patients in non-psychiatric inpatient units with satisfactory sensitivity and specificity.
The availability of ABRAT-H may help provide focused preventive measures that target patients at high risk for violence and reduce violent events.
A majority of the nursing workforce is employed in acute care hospital setting, and the availability of ABRAT-H can further enhance the culture of a safe work environment and have positive impacts not only on the nurses' physical and mental health but also on the quality of patient care.
We have adhered to relevant STROBE guidelines for reporting observational studies.
No Patient or Public Contribution.
完善并验证攻击行为风险评估工具（ABRAT）的电子版，并确定其在非精神科住院病房中识别潜在暴力患者的敏感性和特异性。
采用前瞻性队列研究设计。
纳入2023年2月7日至4月9日期间在美国内布拉斯加州一家急症医院的三个住院病房收治或转来的所有患者。入院的前3天每天进行10项ABRAT评估。收集暴力事件直至患者出院，分为三类：对他人的身体攻击、对财产的身体攻击以及对他人的言语恐吓/威胁。进行肯德尔tau检验和多变量逻辑回归程序，以选择一组最能预测暴力事件的简洁项目。
1179名患者中，69人发生了≥1次暴力事件（5.9%）。修订后的六项加权工具被命名为住院患者ABRAT（ABRAT-H）。受试者工作特征分析的曲线下面积为0.82。截断分数为2分时的敏感性和特异性分别为68.1%和85.2%。随着ABRAT-H分数的增加，暴力患者的百分比也增加，对于分数≥5的患者，55.2%出现暴力行为。
ABRAT-H似乎有助于在非精神科住院病房中识别潜在暴力患者，具有令人满意的敏感性和特异性。
ABRAT-H的可用性可能有助于提供针对暴力高风险患者的重点预防措施，并减少暴力事件。
大多数护理人员受雇于急症医院环境，ABRAT-H的可用性可以进一步加强安全工作环境文化，不仅对护士的身心健康有积极影响，而且对患者护理质量也有积极影响。
我们遵循了报告观察性研究的相关STROBE指南。
无患者或公众贡献。
