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Violence and aggression in the emergency department
  1. A James1,
  2. R Madeley2,
  3. A Dove3
  1. 1University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
  2. 2University of Nottingham Medical School, Division of Epidemiology and Public Health, Queen’s Medical Centre, Nottingham, UK
  3. 3Emergency Department, Queen’s Medical Centre, Nottingham, UK
  1. Correspondence to:
 Alex James
 University of Nottingham Medical School, c/o Medical School Faculty Office, Queen’s Medical Centre, Nottingham, NG7 2UH, UK; alexjames{at}


Objective: To investigate the characteristics of incidents of aggression and violence directed towards staff in an urban UK emergency department.

Methods: A retrospective review of incident report forms submitted over a 1 year period that collected data pertaining to the characteristics of assailants, the outcome of incidents, and the presence of possible contributory factors.

Results: A total of 218 incident reports were reviewed. It was found that the majority of assailants were patients, most were male, and the median age was 32 years. Assailants were more likely to live in deprived areas than other patients and repeat offenders committed 45 of the incidents reported during the study period. The incident report indicated that staff thought the assailant was under the influence of alcohol on 114 occasions. Incidents in which the assailant was documented to have expressed suicidal ideation or had been referred to the psychiatric services were significantly more likely to describe physical violence, as were those incidents in which the assailant was female.

Conclusion: Departments should seek to monitor individuals responsible for episodes of violence and aggression in order to detect repeat offenders. A prospective study comprising post-incident reviews may provide a valuable insight into the causes of violence and aggression.

  • aggression
  • emergency medicine
  • medical staff
  • violence

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  • The University of Nottingham Medical School granted funding to facilitate research by the corresponding author (Alex James) necessary to fulfil the requirements of his Bachelor of Medical Science undergraduate degree. The Medical School assigned a member of the faculty (Richard Madeley) to supervise the design and implementation of the study.

  • Competing interests: none declared

  • Ethical approval: ethical approval was sought and obtained from the Nottingham Research Ethics Committee (application reference number Q1070314)

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