Mallett-Smith Sheila, Olmedo Alirio, Canamar Catherine P
Los Angeles General Medical Center, Los Angeles, CA, United States.
Int J Nurs Stud Adv. 2024 Dec 5;8:100280. doi: 10.1016/j.ijnsa.2024.100280. eCollection 2025 Jun.
There is a lack of high-quality evidence to support the recommendation of an instrument to screen emergency department patients for their risk for violence.
To demonstrate the content and predictive validity and reliability of the novel Risk for Violence Screening Tool to identify patients at risk for violence.
This retrospective risk screening study was conducted at a 100-bed emergency department in an urban, academic, safety net trauma center in Southern California.
Nine subject matter expert employees and 22,583 non-critical adult emergency patients.
Subject matter experts rated the relevance of 30 risk items and 10 domains comprising the Risk for Violence Screening Tool. Content Validity Index/Average Content Validity and Universal Agreement analyses determined the tool's content validity. Predictive validity, analyzed with logistic regression, used data from a patient incidence of violence registry (an incident occurred or did not occur), compared with the Risk for Violence Screening Tool screening result (positive or negative). Response agreement among three nurses who independently utilized the Risk for Violence Screening Tool to assess the same patients upon their arrival at the emergency department determined inter-rater reliability.
The overall Content Validity Index was 0.84, and the item-level Content Validity Index and the universal agreement scores were 1.00, indicating perfect agreement on item relevance and a unanimous consensus among experts. Patients who screened positive on the Risk of Violence Screening Tool, indicating a high probability of violence, were 27.55 times more likely to commit an act of violence compared to those who screened negative (95 % CI = 24.73 to 30.70). The logistic regression model was statistically significant, (χ = 1140.29, < 0.0001), explaining a range from 4.9 % (Cox & Snell ) to 37.3 % (Nagelkerke ) of the variance and indicating that the Risk for Violence Screening Tool successfully predicted violent incidents. The calculated area under the curve of 0.843 (95 % confidence interval, 0.812-0.873, < 0.001) affirmed the Risk for Violence Screening Tool's discriminatory ability to distinguish between individuals with and without a risk for violent behavior. Cohen's Kappa statistic yielded a value of 0.86 ( < 0.001).
The Risk for Violence Screening Tool is valid and reliable. This standardized tool can be used in emergency departments as part of a robust violence prevention program, creating a safer workplace for both staff and patients.
The Risk for Violence Screening Tool (RVST) is a valid and reliable brief screener to identify emergency department patients at risk for violence. @dhs.lacounty @ijn2024.
缺乏高质量证据支持推荐使用某种工具对急诊科患者进行暴力风险筛查。
验证新型暴力风险筛查工具的内容、预测效度及信度，以识别有暴力风险的患者。
这项回顾性风险筛查研究在南加州一家拥有100张床位的城市学术安全网创伤中心的急诊科开展。
9名主题专家雇员和22583名非危急成年急诊患者。
主题专家对构成暴力风险筛查工具的30个风险项目和10个领域的相关性进行评分。内容效度指数/平均内容效度及普遍一致性分析确定该工具的内容效度。通过逻辑回归分析预测效度，使用暴力事件登记册中的患者数据（事件发生或未发生），并与暴力风险筛查工具的筛查结果（阳性或阴性）进行比较。三名护士在患者抵达急诊科时独立使用暴力风险筛查工具对同一患者进行评估，通过反应一致性确定评分者间信度。
总体内容效度指数为0.84，项目级内容效度指数和普遍一致性得分均为1.00，表明专家们对项目相关性意见完全一致且达成了一致共识。暴力风险筛查工具筛查呈阳性（表明暴力可能性高）的患者实施暴力行为的可能性是筛查呈阴性患者的27.55倍（95%置信区间=24.73至30.70）。逻辑回归模型具有统计学意义（χ = 1140.29，< 0.0001），解释了方差的4.9%（考克斯和斯内尔）至37.3%（纳格尔克），表明暴力风险筛查工具成功预测了暴力事件。计算得出的曲线下面积为0.843（95%置信区间，0.812 - 0.873，< 0.001），证实了暴力风险筛查工具区分有暴力行为风险和无暴力行为风险个体的鉴别能力。科恩kappa统计量的值为0.86（< 0.001）。
暴力风险筛查工具有效且可靠。作为强有力的暴力预防计划的一部分，这种标准化工具可在急诊科使用，为工作人员和患者营造更安全的工作场所。
暴力风险筛查工具（RVST）是一种有效且可靠的简短筛查工具，用于识别急诊科有暴力风险的患者。@dhs.lacounty @ijn2024 。
