Violent Reinjury and Mortality Among Youth Seeking Emergency Department Care for Assault-Related Injury

Abstract

IMPORTANCE Violence is a leading cause of morbidity and mortality among youth, with more than 700 000 emergency department (ED) visits annually for assault-related injuries. The risk for violent reinjury among high-risk, assault-injured youth is poorly understood. OBJECTIVE To compare recidivism for violent injury and mortality outcomes among drug-using, assault-injured youth (AI group) and drug-using, non–assault-injured control participants (non-AI group) presenting to an urban ED for care. DESIGN, SETTING, AND PARTICIPANTS Participants were enrolled in a prospective cohort study from December 2, 2009, through September 30, 2011, at an urban level I ED and followed up for 24 months. We administered validated measures of violence and substance use and mental health diagnostic interviews and reviewed medical records at baseline and at each point of follow-up (6, 12, 18, and 24 months). EXPOSURE Follow-up over 24 months. MAIN OUTCOMES AND MEASURES Use of ED services for assault or mortality measured from medical record abstraction supplemented with self-report. RESULTS We followed 349 AI and 250 non-AI youth for 24 months. Youth in the AI group had almost twice the risk for a violent injury requiring ED care within 2 years compared with the non-AI group (36.7% vs 22.4%; relative risk [RR], 1.65 [95% CI, 1.25-2.14]; P < .001). Two-year mortality was 0.8%. Poisson regression modeling identified female sex (RR, 1.30 [95% CI, 1.02-1.65]), assault-related injury (RR, 1.57 [95% CI, 1.19-2.04), diagnosis of a drug use disorder (RR, 1.29 [95% CI, 1.01-1.65]), and posttraumatic stress disorder (RR, 1.47 [95% CI, 1.09-1.97]) at the index visit as predictive of ED recidivism or death within 24 months. Parametric survival models demonstrated that assault-related injury (P < .001), diagnosis of posttraumatic stress disorder (P = .008), and diagnosis of a drug use disorder (P = .03) significantly shortened the expected waiting time until the first ED return visit for violence or death. CONCLUSIONS AND RELEVANCE Violent injury is a reoccurring disease, with one-third of our AI group experiencing another violent injury requiring ED care within 2 years of the index visit, almost twice the rate of a non-AI comparison group. Secondary violence prevention measures addressing substance use and mental health needs are needed to decrease subsequent morbidity and mortality due to violence in the first 6 months after an assault injury.

Nonfatal Assaults Among Persons Aged 10–24 Years — United States, 2001–2015

“…The ED is an important implementation setting for prevention, in part because a large proportion of patients will experience a subsequent assault-related injury or premature death within a few years of a treated injury ( 6 , 7 ). For example, one study compared persons aged 14–24 years who sought treatment in the ED and reported substance use in the 6 months before the visit.…”

“…For example, one study compared persons aged 14–24 years who sought treatment in the ED and reported substance use in the 6 months before the visit. Of the young persons who were seen initially for an assault-related injury, 36.7% were seen again for an assault-related injury within 24 months, compared with 22.4% of the young persons initially seen for other conditions (e.g., unintentional injury or illness) ( 6 ). …”

Long-term mortality of patients surviving firearm violence

“…Beyond being male, part of a racial minority group and uninsured, violent injury and homicide in this group may be predicted by such factors as being part of high-risk social networks, recidivism, delinquency and drug usage 8 13–19. However, the risk of death after non-GSW assault appears to be constant, whereas the deaths in the GSW cohort occurred differentially in the early period after discharge.…”

PTSD, cyberbullying and peer violence: prevalence and correlates among adolescent emergency department patients

“…The need for early diagnosis and treatment may be highest in adolescents with a history of physical peer violence, a population at high risk for future trauma 25,26 . A history of physical peer violence is a strong predictor of PTSD symptoms in adults and adolescents 2,3,27,28 .…”