546 - Applying the DASA-YV for Aggression Risk Reduction in Pediatric Acute Care

Publication Number: 546.3580

Kristen Choi, UCLA, Los Angeles, CA, United States; Grace Sund, UCLA Health/Mattel Children's Hospital, Los Angeles, CA, United States; Theresa Kirkpatrick, UCLA Mattel Childrens Hospital, LA, CA, United States

Background: Pediatric healthcare providers often experience aggression from children and adolescents in hospitals, posing risks to both staff and patients. The Dynamic Appraisal of Situational Aggression Youth Version (DASA-YV) is a tool for assessing youth aggression during hospitalization that has not yet been studied outside of inpatient child/adolescent psychiatry. The purpose of this study was to validate the DASA-YV in pediatric acute care.

Objective: The purpose of this study was to validate the DASA-YV in pediatric acute care.

Design/Methods: The study used an observational design. Pediatric emergency, medical/surgical, and intensive care units at two academic medical centers in Southern California administered the DASA-YV to patients ages 6 to 25 years with a primary or secondary behavioral health diagnosis from 2022 to 2023.

Results: The sample was 201 hospital encounters and 33 had an aggressive incident (16.4%). The most frequent DASA-YV indicator was outside stressors (n=79, 39%), followed by anxiety (n=75, 37%) and irritability (n=58, 29%). We observed higher frequencies of overall aggression (P <.001), object aggression (P <.001), verbal aggression (P <.001), and aggression against people (P <.001) for patients who received a ‘high’ DASA-YV rating during hospitalization. In adjusted models, older children and pediatric acute care encounters (versus emergency encounters) had lower risk for DASA-YV behaviors while males had higher risk. A medium DASA-YV risk rating was associated with an aggressive behavior IRR of 7.49 compared with a low rating (95% CI=2.57–23.03), and an IRR of 36.18 for high ratings compared with low ratings (95% CI=15.94–97.9).

Conclusion(s): The DASA-YV is useful tool for assessing risk for aggression in pediatric acute care settings and may contribute to reduced patient and staff safety incidents related to aggression.