A systematic review of violence risk assessment tools currently used in emergency care settings

Dana Sammut, Nutmeg Hallett, Liz Lees-Deutsch, Geoffrey L. Dickens

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
16 Downloads (Pure)



Background: Violence risk assessment is commonplace in mental health settings and is gradually being employed more often in emergency care. The aim of this review was to examine the psychometric properties, acceptability, feasibility and usability of violence risk assessment tools currently used in emergency care to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so.

Methods: CINAHL, Embase, Medline and Web of Science database searches were supplemented with a search of Google Scholar, which were completed in October 2021. Studies focusing on specialist emergency care pathways were excluded. Risk of bias assessments were made for intervention studies and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken.

Results: Eight studies were included, four describing interventions and four describing tool development/testing. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and one additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence. Despite this, implementation of tools did not reduce restraint use. The quality issues of the studies included in this review are a significant limitation and highlight the need for additional research in this area.

Conclusions: There is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist and examination of their ability to predict which patients are likely to become violent suggests that they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted. The recency of much of the evidence evaluating their effectiveness indicates that this clinical issue is gaining traction.

Original languageEnglish
Pages (from-to)371-386.e5
Number of pages21
JournalJournal of Emergency Nursing
Issue number3
Early online date29 Dec 2022
Publication statusPublished - May 2023

Bibliographical note

Copyright 2022 Emergency Nurses Association. Published by Elsevier Inc.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)


Clive Richards Foundation


  • Patient violence
  • Risk assessment
  • Workplace aggression


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