Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk

Abstract

Background Interpersonal firearm violence among youth is a substantial public health problem, and emergency department (ED) physicians require a clinical screening tool to identify high-risk youth. Objective To derive a clinically feasible risk index for firearm violence. Design 24-month prospective cohort study. Setting Urban, level 1 ED. Participants Substance-using youths, aged 14 to 24 years, seeking ED care for an assault-related injury and a proportionately sampled group of non–assault-injured youth enrolled from September 2009 through December 2011. Measurements Firearm violence (victimization/perpetration) and validated questionnaire items. Results A total of 599 youths were enrolled, and presence/absence of future firearm violence during follow-up could be ascertained in 483 (52.2% were positive). The sample was randomly split into training (75%) and post–score-construction validation (25%) sets. Using elastic-net penalized logistic regression, 118 baseline predictors were jointly analyzed; the most predictive variables fell predominantly into 4 domains: violence victimization, community exposure, peer influences, and fighting. By selection of 1 item from each domain, the 10-point SaFETy (Serious fighting, Friend weapon carrying, community Environment, and firearm Threats) score was derived. SaFETy was associated with firearm violence in the validation set (odds ratio [OR], 1.47 [95% CI, 1.23 to 1.79]); this association remained (OR, 1.44 [CI, 1.20 to 1.76]) after adjustment for reason for ED visit. In 5 risk strata observed in the training data, firearm violence rates in the validation set were 18.2% (2 of 11), 40.0% (18 of 45), 55.8% (24 of 43), 81.3% (13 of 16), and 100.0% (6 of 6), respectively. Limitations The study was conducted in a single ED and involved substance-using youths. SaFETy was not externally validated. Conclusion The SaFETy score is a 4-item score based on clinically feasible questionnaire items and is associated with firearm violence. Although broader validation is required, SaFETy shows potential to guide resource allocation for prevention of firearm violence. Primary Funding Source National Institute on Drug Abuse R01024646.

Age‐Specific Associations Between Violence Exposure and Past 30‐Day Marijuana and Alcohol Use

“…Researchers have consistently identified associations between ETV and negative psychosocial and health outcomes (Boynton-Jarrett, Ryan, Berkman, & Wright, 2008;Dahlberg & Potter, 2001;Fuller-Thomson, Roane, & Brennenstuhl, 2016;Goldstick, Carter et al, 2017;Gorman-Smith, Henry, & Tolan, 2004;Herrenkohl et al, 2000;Schilling, Aseltine, & Gore, 2007), and these associations are often conceptualized as mediated by psychological distresses (Deane et al, 2016). In particular, ETV places adolescents at increased risk of internalizing problems, including major depressive disorders and posttraumatic stress disorder (Deane et al, 2016;Sheidow et al, 2014).…”

Tracking Assault‐injured, Drug‐using Youth in Longitudinal Research: Follow‐up Methods

“…It should be noted that other analyses from this study have examined trajectories of the study population over the 24-month time period. These analyses include joint trajectories of alcohol use and anxiety/depression symptoms over time, 36 prediction of future firearm violence, 37 trajectories of marijuana use, 38 and predictors of assault re-injury. 25…”

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

“…40 One pilot study attempted to create a clinically feasible risk index for firearm violence. 41 The study proposed a 4-item questionnaire (SaFETy score) that evaluated: 1) serious fighting; 2) friend weapon carrying; 3) community environment; and 4) firearm threats to grade risk of future injury from firearm violence. The SaFETy score has shown potential but has not yet been externally validated or applied to individuals >24 years of age or those who do not use substances.…”