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Abstract
Purpose
This study aimed to evaluate the usefulness of a behavioral cue checklist (BCC) containing 17 items developed by Wilkes et al. (2010) for identifying potentially violent patients in emergency departments.
Methods
This was a prospective observational study to evaluate the usefulness of the Korean version of a BCC (K-BCC) as an assessment tool for predicting patient violence in emergency departments, and was conducted over 4 weeks in a regional emergency medical center located in B City. A total of 1,324 patients were finally analyzed.
Results
Logistic regression analysis was performed to investigate whether each item of the K-BCC predicts violence, and a parsimonious set of 8 statistically significant items was selected for the tool. Receiver operating characteristic analysis of the BCC showed that the area under the curve was .97 (95% confidence interval: .94~1.0). The sensitivity, specificity, positive predictive value, and negative predictive value at the cut-off score of 2 were 75.6%, 98.9%, 68.2%, and 99.2%, respectively.
Conclusion
The K-BCC was found to be useful in predicting patient violence toward emergency department staff. This tool is simple, and fast to use and can play a significantly role identifying potentially violent patients. Owing to this advance identification, this tool can be helpful in preventing the potential for violence from manifesting as violent behaviors.
References
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Figure 1.
Behavioral Cue Checklist (BCC) Receiver Operating Characteristics (ROC) curve. Diagonal broken line represents the line of no discrimination with Area Under the Curve (AUC) of .5. Solid curve represents the BCC with AUC of .97 (95% CI=0.94~1.0; p<.001).
Table 1.
General Characteristics and Violence-Related Characteristics (N=1,324)
Table 2.
Comparison of Cue Occurrence Between Violent and Non-Violent Group (N=1,324)
| Cues | Violent Group (N=37) n (%) | Non-violent Group (N=1,287) n (%) | χ2* | p | |
|---|---|---|---|---|---|
| 1 | Threat of harm | 12 (32.4) | 5 (0.4) | 291.36 | <.001 |
| 2 | Clenched fists/Tense posture | 9 (24.3) | 21 (1.6) | 83.63 | <.001 |
| 3 | Name-calling | 11 (29.7) | 5 (0.4) | 259.35 | <.001 |
| 4 | Irritability | 10 (27.0) | 22 (1.7) | 97.74 | <.001 |
| 5 | Sharp or caustic retorts | 13 (35.1) | 5 (0.4) | 323.80 | <.001 |
| 6 | Demanding attention | 12 (32.4) | 11 (0.9) | 210.09 | <.001 |
| 7 | Aggressive statements | 11 (29.7) | 3 (0.2) | 299.09 | <.001 |
| 8 | Resisting healthcare | 13 (35.1) | 8 (0.6) | 274.46 | <.001 |
| 9 | Swearing | 5 (13.5) | 2 (0.2) | 122.03 | <.001 |
| 10 | Walking back and forth to nurses' station | 8 (21.6) | 5 (0.4) | 166.78 | <.001 |
| 11 | Demeaning inflection | 7 (18.9) | 0 (0.0) | 244.78 | <.001 |
| 12 | Humiliating remarks | 1 (2.7) | 0 (0.0) | 34.81 | .028 |
| 13 | Intimidation | 3 (8.1) | 0 (0.0) | 104.58 | <.001 |
| 14 | Prolonged staring at nurse | 9 (24.3) | 3 (0.2) | 232.41 | <.001 |
| 15 | Increased volume of speech | 15 (40.5) | 4 (0.3) | 411.52 | <.001 |
| 16 | Pacing | 4 (10.8) | 5 (0.4) | 57.86 | <.001 |
| 17 | Belligerence | 10 (27.0) | 5 (0.4) | 227.85 | <.001 |
| Number of patients displaying cues | 100 (7.6) | ||||
| Number of patients not displaying cues | 1,224 (92.4) | ||||
Table 3.
Prediction of Violence with Cues
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