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28-06-2011 | General practice | Article

Tool devised for child inpatient aggression risk assessment


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MedWire News: Researchers report that a questionnaire-based tool may be useful for identifying hospitalized children or adolescents who are at high risk for becoming aggressive during inpatient stays.

The Brief Rating of Aggression by Children and Adolescents (BRCHA) "can help emergency department clinicians rapidly categorize children and adolescents into groups with distinctly higher and lower risks for aggression and violence during hospitalization," explain Drew Barzman (Children's Hospital Medical Center, Cincinnati, Ohio, USA) and team.

The findings, published in the Journal of the American Academy of Psychiatry and the Law, also show that age is inversely associated with risk for inpatient aggression and violence.

In a study involving 418 patients hospitalized for psychiatric evaluation and aged 3-19 years, the BRCHA - a 16-question survey - was used during hospital admission to calculate each patient's risk for becoming aggressive during inpatient stay.

The survey asked questions about the patient's psychiatric, behavioural, and criminal history.

During inpatient stay, aggressive acts, such as self-harm, slamming doors, and hitting other people, were committed by 29% of the patients.

Barzman et al found that 14 of the 16 survey questions significantly predicted inpatient aggression, with an overall area under the receiver operating characteristics (ROC) curve (AUC) of 0.72. The team eliminated the two nonsignificant questions from the survey to produce a refined 14-item BRCHA.

Age alone was noted to be inversely associated with inpatient aggression and specific analysis of patient age revealed that it was a good predictor of inpatient aggression, with an AUC of 0.77. When patient age was combined with the 14-item BRCHA score, the accuracy with which aggression was predicted rose to an AUC of greater than 0.80.

Barzman and team now wish to investigate if adding the levels of hormones, such as testosterone and cortisol - which are known to be associated with aggressive behaviour - to BRCHA scoring can improve its accuracy for predicting aggression.

The researchers conclude that the BRCHA tool "shows promise in rapidly assessing risk of inpatient aggression, but further studies are needed to establish the reliability and validity of the instrument."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Lauretta Ihonor

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