BRACHA-S is a 5 item scoring tool that demonstrated moderate discrimination and identified clinically meaningful risk gradients for agitation requiring intervention (ARI) that may support early safety planning.
Additional Information
Objectives: To validate the 5 item Brief Rating of Aggression in Children and Adolescents- Short (BRACHA-S) completed by ER nurses for patients presenting with mental and behavioral health encounters for predicting agitation requiring intervention.
Background: MBH concerns account for about 13% of all pediatric ER visits and approximately 10% require the use of physical or pharmacologic restraints.
Methods: They conducted a prospective observational prognostic validation study in 2 pediatric EDs. After patient arrival with MBH concern, ED nurses completed the BRACHA-S. Discrimination was assessed with AUROC and performance was estimated for a 3 tier model.
Results: Among 472 encounters, 55 (11.7%) had ARI. BRACHA-S scores were associated with ARI (AUROC, 0.72; 95% CI, 0.64–0.79). ARI incidence increased with score: 0, 3.3% (2/60); 1, 6.3% (6/96); 2, 6.4% (7/110); 3, 12.4% (17/137); 4, 31.8% (14/44); and 5, 36.0% (9/25). Scores 0 to 1 had a negative predictive value of 96.7% but a specificity of 13.9%. Scores 4 to 5 had a specificity of at least 89% and a positive predictive value of greater than 33%. Compared with scores 0 to 2, relative risk of ARI was 2.2 (95% CI, 1.1–4.3) for score 3 and 5.9 (95% CI, 3.3–10.7) for scores 4 to 5.
Conclusions: In pediatric ED MBH encounters, the nurse-completed triage BRACHA-S demonstrated moderate discrimination and identified clinically meaningful risk gradients for ARI that may support early safety planning.
References
Lynn Babcock, Lily Klein, Yin Zhang, Nancy Daraiseh, Ryan Siders, Beatrice Thomas, Ryan Murphy, Holly R. Hanson, Bijan Ketabchi, Shelby Tanguay, Drew Barzman, Wendy J. Pomerantz; A Brief Tool to Predict Agitation in Pediatric Emergency Psychiatric Patients. Pediatrics August 2026; 158 (2): e2026076729. 10.1542/peds.2026-076729