Predicting aggressive behavior in psychiatric patients in emergency department: A systematic literature review.

INTRODUCTION: Aggression and violence are major concerns in emergency departments (EDs), and have negative consequences for patient and staff health and safety. Few validated tools exist for identifying patients at risk of agitation. This study conducted a systematic literature review to identify and summarize the scores that predict aggressive behavior in EDs. METHODS: The search included articles published between Jan 1st, 1987, and Dec 31st, 2022, using the terms "aggress*," "violent*," "emergency," "acute," "score," or "scale." RESULTS: Ten scores were found to be relevant, with eight of the developed scores intended for use in EDs. The Aggressive Behavior Risk Assessment Tool (ABRAT) was found to be sensitive (84.3%) and specific (95.3%). The Brøset Violence Checklist (BVC) was highly specific (99.4%), whereas the Violence Screening Checklist (VSC) was less sensitive (57.2%) and specific (45.7%). The violence and aggression (OVA)/BVC checklist was found to significantly decrease the number of security call activations (P < 0.001). The Behavioral Activity Rating Scale (BARS) and OVA/BVC scores were the shortest, with seven and six items, respectively. CONCLUSION: The OVA/BVC checklist is a valuable tool for predicting and preventing violence in the EDs. Future prospective studies should investigate its effectiveness.

Remote dielectric sensing for detecting pulmonary edema in the emergency department.

BACKGROUND: Dyspnea is a common Emergency Department (ED) complaint of which acute pulmonary edema (APE) is a potentially life-threatening etiology. Remote Dielectric Sensing (ReDS™) is a novel, non-invasive, radar based, rapid, point of care vest testing system used to objectively quantify lung fluid content and may be useful in the early diagnosis of APE. OBJECTIVE: To determine the accuracy of ReDS to detect pathologic lung fluid in ED undifferentiated dyspneic patients. METHODS: We performed a prospective convenience sample observation pilot study enrolling adult ED patients with a chief complaint of "shortness of breath." After informed consent, patients were fitted with the ReDS vest and a reading, blinded to the care team, was recorded. A gold standard diagnosis of pulmonary edema, determined by 2 physicians performing a chart review and blinded to ReDs data, was compared to the ReDS reading. RESULTS: Overall, 123 patients were included; 59% (n = 73) were male, mean (SD) age 57.2 (±12) years, 46.3% (n = 57) Hispanic, 34.1%(n = 42) African American, 13.0% (n = 16) Caucasian and 5.7% (n = 7) Asian. The gold standard diagnosis showed pulmonary edema in 38 (30.9%) patients, of which 30 were detected by ReDS. At an optimal cutoff (≥ 37%), ReDS had a Sn of 79.5% (CI 63.5% - 90.5%), Sp of 72.6% (CI 61.8% - 81.8%), a PPV of 57.4% and a NPV of 88.4%. CONCLUSIONS: ReDS is moderately sensitive and specific with an accuracy of 74.8% for pulmonary edema.

Hyperkalemia and Electrocardiogram Manifestations in End-Stage Renal Disease.

Hyperkalemia is one of the more common acute life-threatening metabolic emergencies. The aim of our study is to determine the correlation and accuracy of abnormal ECG parameters as a function of serum potassium concentration in the end-stage renal disease (ESRD) population. We performed a retrospective chart review of emergency department patients presenting with ESRD and receiving emergent hemodialysis treatment. A total of 96 patients, each with five independent ED visits, provided 480 sets of ECGs and electrolytes. Of these, four ECGs were excluded for inability to interpret, leaving a total of 476 patient encounters that met all inclusion criteria. Linear regression analysis on the limited data set for serum potassium versus T/R in V2, V3, and V4, PR, and QRS found weak correlations (r2 = 0.02 to 0.12) with statistical significance <0.05 level for T/R in V2, V3, and V4. In summary, we found that a QRS duration of 120 ms or greater is most predictive of hyperkalemia in the ESRD population. On the other hand, T/R ratio, PR interval and QRS duration have poor correlations with serum potassium and are not predictive of hyperkalemia in patients with ESRD.