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From all of us at JournalFeed, we are so thankful for you! Thanks for learning with us and serving your patients so well.
Written by Shannon Markus
Spoon Feed
The DASA tool to identify patients at high-risk of violence was successfully implemented at triage with high adoption rates, identifying younger, male, and police- or ambulance-arrived patients as higher risk for aggression.
DASA angry patient…
The Dynamic Appraisal of Situational Aggression (DASA) Score identifies patients at risk for engaging in violence within 24 hours in inpatient behavioral health settings. The assessment includes: irritability, impulsivity, unwillingness to follow directions, sensitivity to perceived provocation, easily angered when requests are denied, negative attitudes, and verbal threats. It takes <2 minutes to complete. While not routinely used in EDs, the authors aimed to describe the implementation of DASA scoring at ED triage. The study did not specifically assess reductions in workplace violence.
This multi-center cross-sectional study evaluated the implementation of the DASA score at triage across five Massachusetts EDs from January–December 2023. Among 192,947 adult ED encounters, a DASA score was documented in 80.3% of cases (n=159,154). Higher DASA scores were more common among younger, male patients and those arriving by police or ambulance, consistent with prior literature. Black patients were more likely, and Asian patients less likely, to receive high-risk scores compared with White patients. The study demonstrated high feasibility and adoption of the DASA tool in the ED triage workflow, with minimal demographic bias in scoring assignment. Authors conclude that DASA may serve as an efficient, proactive method to identify at-risk patients and inform early deescalation interventions to enhance workplace safety in emergency care.
How does this change my practice?
Implementing an effective early-alert system for patients at risk of violence is a noble cause, as we know earlier identification and intervention for escalating behavior reduces violent events. I do worry that the DASA scoring may be highly susceptible to bias. Several DASA items (e.g., “negative attitude,” “unwillingness to follow directions”) are inherently subjective, creating space for implicit bias to influence scoring. If clinicians’ perceptions are shaped by preexisting stereotypes, this may perpetuate structural inequities by disproportionately labeling certain groups as “high risk”. That said, protecting the safety of staff and providers is essential. As workplace violence continues to challenge EDs nationwide, an early-alert system has clear potential benefits, and implementation should be paired with training on implicit bias and regular audits of scoring patterns to ensure accurate use.
Source
The Implementation of Dynamic Appraisal of Situational Aggression Score at Emergency Department Triage. Ann Emerg Med. 2025 Oct;86(4):374-383. doi: 10.1016/j.annemergmed.2025.02.023. Epub 2025 Apr 2. PMID: 40172506.
