The Implementation of Dynamic Appraisal of Situational Aggression (DASA) Score at ED Triage
Authors: Costigan AD, O’Connor LC, Slocum C, Barry K, Canellas MM, Sanseverino AM, Proudman E, Plainte K, Shatsky M, Forget J, Reznek MA
Journal: Annals of Emergency Medicine, 2025
Conclusions:
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High feasibility/adoption: Triaging with DASA across 5 EDs achieved broad uptake and operational feasibility.
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Risk profile aligns with prior data: Male sex, younger age, higher ESI acuity, and arrival with police/EMS/air were most associated with high-risk DASA categorization.
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Next step = validation: Study was descriptive; predictive performance (e.g., prospective sensitivity/specificity for violent behavior) remains to be established.
Results:
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Encounters: 192,947 total; 159,154 (80.3%) had a DASA score at triage.
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Patients: 98,751 unique; mean age 51.5 years; 53.5% women.
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High-risk associations: Male, younger, ESI high-acuity, arrivals with police/ambulance/aircraft most often scored high risk.
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Systemwide use: DASA categorized patients into low / moderate / high / imminent risk—distribution reported descriptively with 95% CIs.
Methods:
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Multicenter, retrospective descriptive study of routine DASA scoring at triage (Jan 11–Dec 31, 2023).
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Setting: 5 EDs implementing DASA as part of a workplace-violence mitigation strategy.
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EHR abstraction of DASA scores + demographics; descriptive analysis with 95% CIs for counts/proportions.
Costigan, A.D., O’Connor, L.C., Slocum, C., Barry, K., Canellas, M.M., Sanseverino, A.M., Proudman, E., Plainte, K., Shatsky, M., Forget, J. and Reznek, M.A., 2025. The Implementation of Dynamic Appraisal of Situational Aggression Score at Emergency Department Triage. Annals of Emergency Medicine.