Objective. To study the prevalence, nature and determinants of aggression among inpatients with acquired brain injury.
Background. Patients with acquired brain injury often have difficulty in controlling their aggressive impulses.
Design. A prospective observational study design.
Methods. By means of the Staff Observation Aggression Scale-Revised, the prevalence, nature and severity of aggressive
behaviour of inpatients with acquired brain injury was assessed on a neuropsychiatric treatment ward with 45 beds. Additional
data on patient-related variables were gathered from the patients’ files.
Results. In total, 388 aggressive incidents were recorded over 17 weeks. Of a total of 57 patients included, 24 (42%) patients
had engaged in aggressive behaviour on one or more occasions. A relatively small proportion of patients (n = 8; 14%) was
found to be responsible for the majority of incidents (n = 332; 86%). The vast majority of aggression incidents (n = 270; 70%)
were directly preceded by interactions between patients and nursing staff. In line with this, most incidents occurred at times of
high contact intensity. Aggressive behaviour was associated with male gender, length of stay at the ward, legal status and
hypoxia as the cause of brain injury.
Conclusion. Aggression was found to be highly prevalent among inpatients with acquired brain injury. The results suggest that
for the prevention of aggression on the ward, it may be highly effective to develop individually tailored interventions for the
subgroup with serious aggression problems.
Relevance to clinical practice. Insight into the frequency, nature and determinants of aggressive behaviour in inpatients with
acquired brain injury provides nurses with tools for the prevention and treatment of aggressive behaviour.