Introduction: To assess the prevalence of risk factors for violent injury among young adults treated at an urban emergency department (ED).

Methods: This study is a cross-sectional analysis of data collected as part of a longitudinal study. Enrollment took place in an urban ED in a Level 1 trauma center, June through December 2010. All patients aged 18–24 years were eligible. Patients were excluded if they were incarcerated, critically ill, or unable to read English. Study participants completed a 10-minute multiple-choice questionnaire using previously validated scales: a) aggression, b) perceived likelihood of violence, c) recent violent behavior, d) peer behavior, and e) community exposure to violence.

Results: 403 eligible patients were approached, of whom 365 (90.1%) consented to participate. Average age was 21.1 (95% confidence interval: 20.9, 21.3) years, and participants were 57.2% female, 85.7% African American, and 82.2% were educated at the high school level or beyond. Among study participants, rates of high-risk exposure to individual risk factors ranged from 7.4% (recent violent behavior) to 24.5% (exposure to community violence), with 32.3% of patients showing high exposure to at least one risk factor. When comparing participants by ethnicity, no significant differences were found between White, African-American, and Hispanic participants. Males and females differed significantly only on 1 of the scales – community violence, (20.4% of males vs. 30.3% of females, p¼0.03). Selfreported hostile/aggressive feelings were independently associated with initial presentation for injury associated complaint after controlling for age, sex, and race (odds ratio 3.48 (1.49-8.13).

Conclusion: Over 30% of young adults presenting to an urban ED reported high exposure to risk factors for violent injury. The high prevalence of these risk factors among ED patients highlights the potential benefit of a survey instrument to identify youth who might benefit from a targeted, ED-based violence prevention program. [West J Emerg Med. 2013;14(4):303–308.]

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.