Predictive Validity of Violence Screening Tools in Emergency and Psychiatric Services: A Systematic Review.

In 30 seconds

This systematic review assessed the predictive validity of tools used to screen for violence toward healthcare workers in emergency and psychiatric services. It identified 62 eligible longitudinal studies, all conducted in psychiatric departments; ten were judged to have lower risk of bias. These higher-quality studies evaluated eight instruments, four of which had acceptable to outstanding predictive performance. The Dynamic Appraisal of Situational Aggression and the Brøset Violence Checklist performed best and had also been validated in emergency departments, where the review considered them suited to short-term risk prediction.

Key findings

• Of 62 eligible studies, ten had lower risk of bias; inadequate reporting of calibration was a main source of high risk of bias.
• The ten higher-quality studies assessed eight instruments, four of which showed acceptable to outstanding predictive performance.
• The Dynamic Appraisal of Situational Aggression and Brøset Violence Checklist had the best predictive performance and were validated in emergency departments.

Why it matters

Violence-risk screening may contribute to staff safety, but predictive performance varies across instruments and settings. The review highlights the importance of matching a tool to the population, how violence is defined, and the monitoring purpose. It also places screening within a broader, multicomponent safety strategy rather than presenting it as a stand-alone solution.

What to keep in mind

All included studies were conducted in psychiatric departments, limiting the evidence base across settings. Many studies had high risk of bias, primarily because calibration measures were not reported.