Screening for violence risk factors identifies young adults at risk for return emergency department visit for injury
Abstract
Introduction: Homicide is the second leading cause of death among youth aged 15–24. Prior crosssectionalstudies, in non-healthcare settings, have reported exposure to community violence, peerbehavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies havenot been performed to evaluate the temporal or predictive relationship between these risk factors andemergency department (ED) visits for injuries among at-risk youth. The objective was to assesswhether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period.
Methods: This prospective cohort study was performed in the ED of a Southeastern US Level I traumacenter. Eligible participants were patients aged 18–24, presenting for any chief complaint. We excludedpatients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurredover a 6-month period, by a research assistant in the ED for 3–5 days per week, with shifts scheduledsuch that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initialcontact in the ED, patients were asked to complete a written questionnaire, consisting of previouslyvalidated instruments measuring the following risk factors: a) aggression, b) perceived likelihood ofviolence, c) recent violent behavior, d) peer behavior, e) community exposure to violence, and f)positive future outlook. At 12 months following the initial ED visit, the participants’ medical records werereviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chisquareand logistic regression analyses.
Results: Three hundred thirty-two patients were approached, of whom 300 patients consented.Participants’ average age was 21.1 years, with 60.1% female, 86.0% African American. Aftercontrolling for participant gender, ethnicity, or injury complaint at time of first visit, return visits forinjuries were significantly associated with: hostile/aggressive feelings (Odds ratio (OR) 3.5, 95%Confidence interval (CI): 1.3, 9.8), self-reported perceived likelihood of violence (OR 10.1, 95% CI: 2.5,40.6), and peer group violence (OR 6.7, 95% CI: 2.0, 22.3).
Conclusion: A brief survey of risk factors for violence is predictive of increased probability of a returnvisit to the ED for injury. These findings identify a potentially important tool for primary prevention ofviolent injuries among at-risk youth seen in the ED for trauma-related and non-traumatic complaints.