Aggression, violence and threatening behaviour during critical illness

Màiri H Northcott; Gemma Johnston; Jeffrey J Presneill; Timothy N Fazio; Nathaniel Adamson; Melissa J Ankravs; Lewis Hackenberger; Yasmine Ali Abdelhamid; Christopher M MacIsaac; Adam M Deane

doi:10.1016/j.ccrj.2023.05.002

Aggression, violence and threatening behaviour during critical illness

Crit Care Resusc. 2023 Jun 30;25(2):65-70. doi: 10.1016/j.ccrj.2023.05.002. eCollection 2023 Jun.

Authors

Màiri H Northcott¹, Gemma Johnston², Jeffrey J Presneill^{1

3}, Timothy N Fazio^{4

5}, Nathaniel Adamson⁶, Melissa J Ankravs^{1

3

7}, Lewis Hackenberger¹, Yasmine Ali Abdelhamid^{1

3}, Christopher M MacIsaac^{1

3}, Adam M Deane^{1

3}

Affiliations

¹ Intensive Care Unit, Royal Melbourne Hospital, Australia.
² Department of Anaesthesia, Royal Melbourne Hospital, Australia.
³ Department of Critical Care Medicine, Melbourne Medical School, University of Melbourne, Australia.
⁴ Business Intelligence Unit, Royal Melbourne Hospital, Australia.
⁵ Department of Medicine, Melbourne Medical School, University of Melbourne, Australia.
⁶ Intensive Care Unit, Gold Coast University Hospital, Australia.
⁷ Department of Pharmacy, Royal Melbourne Hospital, Australia.

Abstract

Objective: This article aims to quantify prevalence of patient aggression or threatened/actual violence during critical illness.

Design: This is a retrospective cohort study.

Setting: This study was conducted in single adult trauma intensive care unit (ICU).

Participants: Patients aged 18 years or over, admitted between January 2015 and December 2020, who triggered a "Code Grey" response due to aggression or threatened/actual violence.

Main outcome measure: The primary outcome was prevalence of Code Grey events. Secondary outcomes included unadjusted and adjusted (logistic mixed model) effects of patient demographics, diagnoses and severity of illness on Code Grey events.

Results: There were 16175 ICU admissions relating to 14085 patients and 807 Code Grey events involving 379 (2.7%) patients. The observed count of events increased progressively from 2015 (n = 77) to 2020 (n = 204). For patients with a Code Grey, the median count of events was 3 (range 1-33). Independent predictors of at least one ICU Code Grey event included male sex (OR 2.5; 95% CI 1.8 to 3.4), young age (most elevated odds ratio in patients 20-30 years), admission from the emergency department (OR 2.8, 95% CI 2.1 to 3.6) and a trauma diagnosis (OR 1.4, 95% CI 1.1 to 1.9). Code Grey patients had longer admissions with a reduced risk of death.

Conclusions: The prevalence of Code Grey events in ICU appears to be increasing. Patients may have repeated events. Younger male patients admitted to ICU via the emergency department with a trauma or medical diagnosis are at greatest risk of a Code Grey event.

Keywords: Anaesthesia and intensive care; Drugs and alcohol; Intensive care; Social issues; Trauma.