Applying the DASA-YV for aggression risk reduction in pediatric acute care.

Abstract

Purpose: Pediatric nurses frequently face aggression from children and adolescents, posing risks to both staff and patients. The Dynamic Appraisal of Situational Aggression Youth Version (DASA-YV) assesses aggression in youth but has only been studied in inpatient psychiatry and certain institutional settings, such as juvenile justice and residential care.

Design and methods: This study aimed to validate the DASA-YV in pediatric acute care settings, using an observational design across pediatric emergency, medical/surgical, and intensive care units at two academic medical centers in Southern California. The DASA-YV was administered to patients ages 6 to 17 years with a primary or secondary behavioral health diagnosis from 2022 to 2023.

Results: The sample included 201 hospital encounters, of which 33 involved aggressive incidents (16.4 %). The most frequent DASA-YV indicators were outside stressors (39 %), anxiety (37 %), and irritability (29 %). Patients with a 'high' DASA-YV rating showed higher frequencies of overall aggression (P < .001), object aggression (P < .001), verbal aggression (P < .001), and aggression against people (P < .001). In adjusted models, older children and pediatric acute care encounters had a lower risk of aggression, while males had a higher risk. A medium DASA-YV risk rating was associated with an aggressive behavior incidence rate ratio (IRR) of 7.49, and a high rating had an IRR of 36.18. In ROC analysis, the AUC was 0.94, (95 % CI: 0.90-0.98) indicating strong model performance for classifying aggressive incidents.

Conclusions and practice implications: The DASA-YV is a valuable tool for assessing aggression risk in pediatric acute care, enhancing patient and staff safety.