Violent and Fatal Youth Trauma: Is There a Missed Opportunity?

Abstract

IntroductionAccidents and assaults (homicides) are the leading causes of death among the youth of the United States, accounting for 53.3% of deaths among children aged 1 to19 years. Victim recidivism, defined as repeated visits to the emergency department (ED) as a victim of violent trauma, is a significantly growing public health problem. As 5-year mortality rates for recidivism are as high as 20%, it is important to determine whether victims with a history of violent trauma are at increased risk for fatal outcome with their next trauma. We hypothesized that victims of violent trauma who have had 1 prior ED visit for violent trauma will have increased odds of fatal outcome.MethodsA retrospective chart review was conducted for patients presenting with penetrating trauma to the ED from January 1, 1999 to December 31, 2009. All patients between the ages of 15 to 25 years who presented to the ED for any penetrating trauma were included. Patients with prior presentations for penetrating trauma were compared to those patients who were first-time presenters to determine the odds ratio of fatal outcome.ResultsOverall, 15,395 patients were treated for traumatic presentations. Of these, 1,044 met inclusion criteria. Demographically, 79.4% were Hispanic, 19.4% were African American, and 0.96% were Caucasian. The average age was 21 years, and 98% of the population was male. One hundred and forty-seven (14%) had prior presentations, and 897 (86%) did not. Forty of the 147 patients (27%) with prior presentations had a fatal outcome as compared to 29 patients of the 868 (3%) without prior presentations, with odds ratio of 10.8 (95% confidence interval, 6.4–18.1; Pearson χ2, P < 0.001). The 5-year mortality rate for those patients with fatal outcomes was calculated at 16.5%.ConclusionPatients who had prior ED visits for penetrating trauma were at greater risk for fatal outcomes compared to those with no prior visits. Therefore, trauma-related ED visits might offer an opportunity for education and intervention. This may help to prevent future fatalities.

Cost−Benefit Analysis Simulation of a Hospital-Based Violence Intervention Program

“…Furthermore, this study focused on violent reinjury at 5-year follow-up and should be considered within the context of research that has assessed violent reinjury at different follow-up periods. [18][19][20][21][22][23][24] The present study highlights the need for a systematic review of the violent reinjury literature. The analysis reported here is based on numerous assumptions and has several limitations.…”

“…7,8 HVIP services are provided by case workers who understand the life experiences of violently injured patients. HVIPs are grounded in empirical data about the recurrent nature of violent injury [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] and the theory that hospitals offer a unique opportunity for intervention. 7,8 HVIPs have shown effectiveness in preventing violent reinjury and perpetration; in improving employment, education, and healthcare utilization; and in reducing aggressive behaviors.…”

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

“…2 Recurrent injury is a promising target for prevention, as prior injury is a predictor of future violent injury 3 and death. 4–6 Hospital-based violence intervention programs show promising results with in reducing re-injury and costs by using an initial injury visit to initiate prevention, 7,8 but appropriately scaling and distributing violence prevention resources requires a more accurate understanding of the incidence, risk factors, and impact of recurrent violent injury.…”

Interpersonal violence and violent re‐injury in the Northern Territory

“…Published data from North America suggest IPV recidivism is as high as 36.7% at 24 months, 11 trauma recidivism is associated with greater long-term mortality, 12 and IPV fatalities are up to 10 times more likely to have had prior IPV presentation. 13 To our current knowledge, this is the first Australian study to examine violent re-injury in a hospitalised population. The rate of 43% is likely to be an underestimate, as our study did not include the hidden burden of unreported case, victim deaths prior to arrival to hospital, and data from remote community health centres.…”

“…The finding that 43% of persons in this study had a prior presentation for violence‐related injury supports the notion that for a large proportion of NT victims, IPV is a recurrent disease. Published data from North America suggest IPV recidivism is as high as 36.7% at 24 months, trauma recidivism is associated with greater long‐term mortality, and IPV fatalities are up to 10 times more likely to have had prior IPV presentation …”