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Open Access Research article

Predicting inpatient violence using an extended version of the Brøset-Violence-Checklist: instrument development and clinical application

Christoph Abderhalden1*, Ian Needham2, Theo Dassen3, Ruud Halfens4, Hans-Joachim Haug5 and Joachim Fischer6

Author Affiliations

1 University Bern Psychiatric Services, Nursing and Social Education Research Unit, Bolligenstrasse 111, 3000 Bern 60, Switzerland

2 University of Applied Science, Route des Cliniques 15, 1700 Fribourg, Switzerland

3 Humboldt-University, Department of Nursing Science, Schumannstr. 20/21, 10117 Berlin, Germany

4 Universiteit Maastricht, Faculty of Health science, P.O. Box 616, 6200 MD Maastricht, The Netherlands

5 University Zurich and, Psychiatric Hospital Schloessli, 8618 Oetwil am See, Switzerland

6 Department of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Theodor Kutzer Ufer 1, D-68135 Mannheim, Germany

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BMC Psychiatry 2006, 6:17  doi:10.1186/1471-244X-6-17

Published: 25 April 2006



Patient aggression is a common problem in acute psychiatric wards and calls for preventive measures. The timely use of preventive measures presupposes a preceded risk assessment. The Norwegian Brøset-Violence-Checklist (BVC) is one of the few instruments suited for short-time prediction of violence of psychiatric inpatients in routine care. Aims of our study were to improve the accuracy of the short-term prediction of violence in acute inpatient settings by combining the Brøset-Violence-Checklist (BVC) with an overall subjective clinical risk-assessment and to test the application of the combined measure in daily practice.


We conducted a prospective cohort study with two samples of newly admitted psychiatric patients for instrument development (219 patients) and clinical application (300 patients). Risk of physical attacks was assessed by combining the 6-item BVC and a 6-point score derived from a Visual Analog Scale. Incidents were registered with the Staff Observation of Aggression Scale-Revised SOAS-R. Test accuracy was described as the area under the receiver operating characteristic curve (AUCROC).


The AUCROC of the new VAS-complemented BVC-version (BVC-VAS) was 0.95 in and 0.89 in the derivation and validation study respectively.


The BVC-VAS is an easy to use and accurate instrument for systematic short-term prediction of violent attacks in acute psychiatric wards. The inclusion of the VAS-derived data did not change the accuracy of the original BVC.