A Case for Risk Stratification in Survivors of Firearm and Interpersonal Violence in the Urban Environment

Walker, Garth N; Dekker, Annette M.; Hampton, David A.; Akhetuamhen, Adesuwa; Moore, P. Quincy

doi:10.5811/westjem.2020.8.45041

Cited by 9 publications

(4 citation statements)

References 49 publications

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“…In the USA, it is estimated that ~180 000 non-fatal Emergency Department visits and 2000 pediatric deaths annually are owing to firearm and assault injuries-related to interpersonal violence 39 . There are concerning demands a social contribution by psychological intervention and violence prevention, and those efforts must be intense, multipronged, and thoughtful, making them effective and available to children and adolescents injured by self-harm and interpersonal violence 40 , 41 .…”

Section: Discussionmentioning

confidence: 99%

Global burden of all cause-specific injuries among children and adolescents from 1990 to 2019: a prospective cohort study

Li,

Jiao,

Hua

et al. 2024

International Journal of Surgery

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Background: To assess the burden and change in incidence, death, and disability-adjusted life years (DALYs) for all-cause-specific injuries among children and adolescents in 204 countries and territories between 1990 and 2019. Materials and Methods: Data were extracted from the Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019). Global, regional, and country-level age-standardized rate (per 100,000) of incidence (ASRI), mortality (ASRM), and DALYs (ASRD) with 95% uncertainty interval (95% UI) of injuries were estimated by age, sex, socio-demographic index (SDI), and all-cause specific injuries from 1990 to 2019. Results: Overall, the ASRI, ASRM, and ASRD of injury were 9006.18 (95%UI: 7459.74 to 10918.04), 23.04 (20.00 to 26.50), and 2020.19 (1759.47 to 2318.64) among children and adolescents worldwide in 2019, respectively. All the above indicators showed a downward trend from 1990 to 2019. In level 2 cause of injury, both the global transport injury and unintentional injury declined during the study years, while self-harm and interpersonal violence-related injury showed an increasing trend. High SDI regions had higher ASRI of injuries, but low SDI regions had higher ASRM and ASRD of injuries globally in 2019. Males had a higher burden of injuries than those in females. The ASRI of injuries is higher in adolescents aged 15-19 years, whereas the mortality and DALYs rate are higher among children under 5 years old. Moreover, adolescents aged 15-19 years and individuals living in Central Asia, Middle East, and Africa had higher ASRI, ASRM, and ASRD of injuries owing to self-harm and interpersonal violence. Generally, falls and road traffic injuries are the leading cause of injury among the population aged 0-19 years worldwide, but self-harm, interpersonal violence, and conflict and terrorism are also leading types of injuries in some regions, particularly in Low- and Middle-Income Countries. Conclusions: Injury remains a major global public health problem among children and adolescents, although its burden at the worldwide level showed a decreasing trend from 1990 to 2019. Of concern, the burden of injuries caused by transport injuries, and unintentional injuries has shown a downward trend in most countries, while the burden caused by self-harm and interpersonal violence has shown an upward trend in most countries. These findings suggest that more targeted and specific strategies to prevent the burden of injuries should be reoriented, and our study provides important findings for decision-makers and healthcare providers to reduce injury burden among children and adolescents.

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Section: Discussionmentioning

confidence: 99%

Global burden of all cause-specific injuries among children and adolescents from 1990 to 2019: a prospective cohort study

Li,

Jiao,

Hua

et al. 2024

International Journal of Surgery

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“…Violence is a pervasive public health problem and leading cause of morbidity and mortality in the U.S. (Sumner et al 2015 ). A violent injury treated in the emergency department often represents the only access point to the healthcare system for those most at risk for violent re-injury (Rowhani-Rahbar et al 2015 ; Cunningham et al 2012 ; Garth et al 2020 ). Up to 50% of patients injured by violence may suffer violent re-injury within 5 years following hospital discharge (Corbin et al 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Barriers to recruitment, retention and intervention delivery in a randomized trial among patients with firearm injuries

et al. 2021

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Background We discuss barriers to recruitment, retention, and intervention delivery in a randomized controlled trial (RCT) of patients presenting with firearm injuries to a Level 1 trauma center. The intervention was adapted from the Critical Time Intervention and included a six-month period of support in the community after hospital discharge to address recovery goals. This study was one of the first RCTs of a hospital- and community-based intervention provided solely among patients with firearm injuries. Main text Barriers to recruitment included limited staffing, coupled with wide variability in length of stay and admission times, which made it difficult to predict the best time to recruit. At the same time, more acutely affected patients needed more time to stabilize in order to determine whether eligibility criteria were met. Barriers to retention included insufficient patient resources for stable housing, communication and transportation, as well as limited time for patients to meet with study staff to respond to follow-up surveys. These barriers similarly affected intervention delivery as patients who were recruited, but had fewer resources to help with recovery, had lower intervention engagement. These barriers fall within the broader context of system avoidance (e.g., avoiding institutions that keep formal records). Since the patient sample was racially diverse with the majority of patients having prior criminal justice system involvement, this may have precluded active participation from some patients, especially those from communities that have been subject to long and sustained history of trauma and racism. We discuss approaches to overcoming these barriers and the importance of such efforts to further implement and evaluate hospital-based violence intervention programs in the future. Conclusion Developing strategies to overcome barriers to data collection and ongoing participant contact are essential to gathering robust information to understand how well violence prevention programs work and providing the best care possible for people recovering from injuries. Trial registration ClinicalTrials.govNCT02630225. Registered 12/15/2015.

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“… 21 Throughout the country, physicians and hospital systems have joined the effort to help reduce gun violence in their respective communities with some success. 1 , 22 Between 1999–2001, for example, the R. Adams Cowley Shock Trauma Center in Baltimore, MD, implemented and reviewed a HVIP. 23 This model used a multidisciplinary approach, including conflict resolution and public safety issues, recovery from injury, development of positive skills/support, and connection to community services.…”

Section: Discussionmentioning

confidence: 99%

Gun Violence and Firearm Injuries in West Michigan: Targeting Prevention

Mattson¹,

Kaylor²,

Koehler³

et al. 2021

WJEM

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Introduction Firearm-related deaths and injuries are ongoing public health issues in the United States. We reviewed a series of gun violence- and firearm-related injuries treated at a multi-campus community healthcare system in West Michigan to better understand the demographic and clinical characteristics of these injuries. We also studied hospital charges, and payers responsible, in an effort to identify stakeholders and opportunities for community- and hospital-based prevention. Methods We performed a retrospective review of firearm injuries treated at Mercy Health Muskegon (MHM) between May 1, 2015 and June 30, 2019. Demographic data, injury type, Injury Severity Score (ISS), anatomic location and organ systems involved, length of stay (LOS), mortality, time of year, and ZIP code in which the injury occurred were reviewed, as were hospital charges and payers responsible. Results Of those reviewed, 307 firearm-related injuries met inclusion criteria for the study. In 69.4% of cases the injury type was attempted murder or intent to do bodily harm. Accidental and self-inflicted injuries accounted for 25% of cases. There was a statistically significant difference in the mechanism of injury between Black and White patients with a higher proportion of Black men injured due to gun violence (P < 0.001). Median ISS was 8 and the most commonly injured organ system was musculoskeletal. Median LOS was one day. Self-inflicted firearm injuries had the highest rate of mortality (50%) followed by attempted murder (7%) and accidental discharge (3.1%; P < 0.001). Median hospital charge was $8,008. In 68% of cases, Medicaid was the payer. MHM received $4.98 million dollars in reimbursement from Medicaid; however, when direct and indirect costs were taken into account, a loss of $12,648 was observed. Conclusion Findings from this study reveal that young, Black men are the primary victims of gun violence-related injuries in our West Michigan service area. Hospital care of firearm-related injuries at MHM was predominantly paid for by Medicaid. Multiple stakeholders stand to benefit from funding and supporting community- and hospital-based prevention programs designed to reduce gun violence and firearm-related injuries in our service area.

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A Case for Risk Stratification in Survivors of Firearm and Interpersonal Violence in the Urban Environment

Cited by 9 publications

References 49 publications

Global burden of all cause-specific injuries among children and adolescents from 1990 to 2019: a prospective cohort study

Global burden of all cause-specific injuries among children and adolescents from 1990 to 2019: a prospective cohort study

Barriers to recruitment, retention and intervention delivery in a randomized trial among patients with firearm injuries

Gun Violence and Firearm Injuries in West Michigan: Targeting Prevention

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