{
  "abstract": "Background: To assess the frequency of delirium coinciding with aggressive and/or violent patient behavior in intensive care unit (ICU) patients as documented by nurses and to identify clinical associations or risk factors.\n\nMethods: This was a retrospective observational cohort study conducted at University Hospital Basel in Switzerland including data from 2023-2024. Data collected included demographics, treatment characteristics, clinical scores (including the Richmond Agitation-Sedation Score [RASS] and the Intensive Care Delirium Screening Checklist [ICDSC]) and interventions. The primary objective was to assess the prevalence of delirium in patients with aggressive/violent behavior within ±72 hours of incidents. Secondary objectives included identifying independent associations with violence via uni- and multivariable logistic regression.\n\nResults: Of 10,817 ICU patients, 300 (2.8%) were reportedly aggressive or violent. Delirium occurred in 89.3% of patients within 72 hours of the event and 76.7% were delirious at event. Violence was mostly physical (80.4%), with 22.2% preceded by aggression within a median of 21.6 hours. Multivariable analyses identified an increasing RASS (OR = 1.46 per increasing unit ; p = 0.001) and ICDSC (OR = 1.14 per increasing unit ; p = 0.039) before the violent incident as independent associations. Management shifted from verbal de-escalation for aggression to more invasive measures for violence; sedation rose from 45.3% to 69.8% (p < 0.001), restraint use from 20.0% to 43.1% (p < 0.001) and sedation-related complications reached 64.9%. Unchanged one-on-one nursing rates indicate a reliance on restrictive measures over staffing increases.\n\nConclusions: While ICU-related aggression and violence is rarely reported, the independent association of increasing RASS/ICDSC scores before violence and a prodromal phase of aggression in many cases provide a warning pattern. Identifying these early signs could allow for proactive de-escalating intervention, potentially reducing the need for physical restraints and heavy sedation.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "Sebastian Berger",
      "orcid": "0009-0006-0654-6479"
    },
    {
      "name": "Anja I. Frei"
    },
    {
      "name": "Pascale Grzonka"
    },
    {
      "name": "Simon A. Amacher"
    },
    {
      "name": "Caroline E. Gebhard"
    },
    {
      "name": "Sabina Hunziker"
    },
    {
      "name": "Raoul Sutter"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b0ttmzbw3khfb.bib",
  "cited_by": 0,
  "doi": "10.1186/s12916-026-05291-z",
  "fulltext_url": null,
  "id": "b0ttmzbw3khfb",
  "issns": [
    "1741-7015"
  ],
  "landing_url": "https://link.springer.com/10.1186/s12916-026-05291-z",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2706|Intensive Care Unit Cognitive Disorders"
    ]
  ],
  "openalex": "W7220840063",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-07",
  "publisher": "Springer Science and Business Media LLC",
  "ris": "https://research.draconitic.com/paper/b0ttmzbw3khfb.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:53Z",
      "native_id": "10.1186/s12916-026-05291-z",
      "source": "crossref",
      "url": "https://link.springer.com/10.1186/s12916-026-05291-z"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2706|Intensive Care Unit Cognitive Disorders",
      "subfield": "general"
    }
  ],
  "title": "Incidence and predictors of delirium-associated violence towards healthcare workers in a Swiss ICU: results from the CAVE study",
  "title_text": "Incidence and predictors of delirium-associated violence towards healthcare workers in a Swiss ICU: results from the CAVE study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:53Z",
  "url": "https://research.draconitic.com/paper/b0ttmzbw3khfb",
  "venue": "BMC Medicine",
  "versions": []
}