Lit Matters 1: DASA Score at ED Triage

Emergency department workplace violence is common, costly, and hard to anticipate at triage. The Dynamic Appraisal of Situational Aggression score is a 7-item, 120-second screen that proved feasible across five EDs, but outcome benefit and bias remain the central unanswered questions.

DASA Score at ED Triage

• Rapid triage screening tool: DASA is a 7-item aggression-risk screen that takes about 120 seconds and was embedded directly into Epic, making it practical for routine triage workflow in a large mixed academic-community ED system.
• System-wide feasibility signal: Triage nurses assigned a DASA score in more than 80% of adult encounters across 192,947 visits, a strong implementation signal for real-world ED use. We get into what likely made uptake work in the episode.
• Risk strata at a glance: Scores were grouped as low risk at 0, moderate at 1 to 3, high at 4 to 5, and imminent risk above 5, giving teams a shared language for situational aggression at the bedside.
• Who scored higher: Higher-risk scores clustered with male sex, younger age, higher ESI acuity, and arrival by police, ambulance, or air, with police arrival showing the strongest association.
• Bias and validity concern: Black race was associated with higher scores, raising a major concern that any operational value could come bundled with racial bias unless prospective validation addresses it directly.
• Feasible not outcome-proven: This was a descriptive single-system study, so it supports feasibility and pattern recognition but does not show fewer assaults, safer staff, or better patient outcomes after DASA implementation.