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Youth with assault-related injury twice as likely to return to ED for violent re-injury
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Recent data show adolescents who presented to the ED with assault-related injuries were nearly twice as likely as their peers with non-assault injuries to return to the ED for another violent injury 2 years after initial discharge.
Rebecca M. Cunningham, MD, of the University of Michigan School of Medicine in Ann Arbor, and colleagues assessed patients aged 14 to 24 years at an urban public ED in Flint, Mich., who presented with an assault-related injury (n=349) or non-assault-related injury (n=250) and self-reported drug use in the past 6 months. Assaults were defined as any injury intentionally caused by another person. In addition to baseline assessments, participants were surveyed at 6, 12, 18 and 24 months.
Rebecca M. Cunningham
Approximately 64.8% of study participants (n=226) were assaulted with a blunt object; 20% sustained a firearm injury and 15.2% had cut or pierced wounds. Seventy-five percent of patients with non-assault injuries sought acute medical care and 24.4% presented for unintentional injury.
Nearly 37% of patients with assault-related injuries returned to the ED for an assault-related re-injury. Approximately 22.4% of patients with non-assault-related injuries returned to the ED for an assault-related injury.
Patients who initially presented with assault-related injuries had a relative risk of 1.65 (95% CI, 1.25-2.14) for assault 2 years after index ED visit compared with patients who presented with non-assault-related injuries.
Seventy-six percent of those who returned for assault injuries only returned once during the 2-year study period, with a mean number of 1.4 assault-related visits.
Overall, participants with assault-related injuries had a greater number of return visits for assault (P<.001). Approximately 9.5% of participants with assault-related injuries returned more than once, compared with 4.4% among participants with non-assault-related injuries (P=.02).
Most return visits occurred in the first 6 months after index visit, according to researchers. Of those who returned, 3.2% returned with a firearm injury. Four out of 70 (6%) participants with an initial firearm injury returned for re-injury with a firearm.
Overall mortality among participants with an assault-related injury was 0.8%; five deaths occurred during the study period. Three of the five deaths were due to violence, one was due to substance use overdose and one was due to a motor vehicle crash, according to researchers.
Poisson regression analysis indicated that assault injury at baseline visit, active posttraumatic stress disorder symptoms at baseline, drug use disorder at baseline and female sex predicted use of ED services for assault during the 2-year study period.
Assault-related injury (P<.001), PTSD diagnosis (P=.008) and drug use disorder diagnosis (P=.03) significantly shortened time to return ED visit for violence or until death.
Participants who presented with non-assault-related injuries who did not have a PTSD diagnosis or a drug use disorder had an estimated 20% chance of returning to the ED within 48 months, compared with 40% among participants without these diagnoses who presented with assault-related injuries. Participants who presented with assault-related injuries and were diagnosed with PTSD or a drug use disorder had a 60% chance of returning to the ED.
“Future violence interventions for youth sustaining assault-related injury may be most effective in the first 6 months after injury, which is the period with the highest risk for recidivism,” the researchers wrote. “These interventions may be most helpful if they address substance use and PTSD to decrease future morbidity and mortality.”
Disclosure: The researchers report no relevant financial disclosures.
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