Introduction of the Broset Violence Checklist in the emergency department: A retrospective cohort study

Objective: The Broset Violence Checklist (BVC) can stratify the risk of violence and aggression in EDs. The aim of the present study was to report the initial uptake of introducing this checklist and associations with unplanned alerts to potential or actual violence in two EDs. Methods: The BVC was recommended in all patient care episodes. This retrospective review included routinely collected data from an adult tertiary referral hospital and a suburban mixed paediatric and adult ED over a 12-month period. The primary outcome variable was completion of at least one BVC score and the secondary outcome was unplanned alerts to potential or actual violence episodes within the EDs. Results: There were 121 330 presentations, of which 108 274 were included in the present study. The BVC was completed for 42 675 (39.4%) presentations. Using a cut-off score of 3, BVC had a specificity of 99.2% (95% confidence interval [CI] 99.1–99.2) and a sensitivity of 15.6% (95% CI 12.5–19.3) for unplanned alerts to potential or actual violence events. Completion of a BVC was independently associated with more unplanned alerts to potential or actual violence events (adjusted odds ratio 1.37; 95% CI 1.12–1.66). Conclusions: The BVC was highly specific for violence and aggression but had low sensitivity. Completion of the BVC was associated with more frequent unplanned alerts to potential or actual violence events, suggesting that high-risk patients might be identified intuitively, without formal scoring. Further exploration of the utility of the BVC in the ED is indicated with a focus on strategies to prevent violence and aggression.