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.