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Emergency Department Usage Patterns Among Pediatric Victims of Gun Violence and Physical Assault
Mary Elizabeth Bernardin, Keven O Cutler1
1From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Missouri School of Medicine, Columbia, MO.
Insights
Pediatric emergency department visits for violence, mental health, or sexual assault predict future violent injuries. Identifying these patterns can help prevent recurrent violence in children and adolescents.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Trauma Surgery
Background:
- Violent injuries are a significant cause of pediatric emergency department (ED) visits.
- Gun violence is the leading cause of violent death among children.
- Understanding patterns of ED usage can help identify at-risk youth.
Purpose of the Study:
- To assess patterns of pediatric ED usage associated with future violent injury visits.
- To identify predictors of recurrent physical assault (PA) and gunshot wound (GSW) visits.
Main Methods:
- Case-control study of youths aged 6-19 presenting with PA or GSW.
- Compared to age-, race-, and sex-matched controls with nonviolent complaints.
- Analyzed previous ED visits for PA, mental/behavioral health, sexual/reproductive health, sexual assault, and child abuse concerns.
Main Results:
- PA and GSW groups had 4-8 times more prior ED visits for various concerns than controls.
- Previous ED visits for mental/behavioral health, sexual/reproductive health, sexual assault, and PA predicted future PA visits.
- Male sex and prior PA visits predicted future GSW visits; 2-9% of patients experienced subsequent GSWs.
Conclusions:
- ED visits for interpersonal violence, mental health, sexual health, and sexual assault are linked to recurrent violent injuries.
- Identifying these patterns can help pinpoint high-risk patients.
- This awareness can enhance opportunities for preventative interventions against violence.
Objective:
Violent injuries are a common reason for pediatric emergency department (ED) visits, with gun violence being the leading cause of violent death among children. The objective of this study was to assess for patterns of pediatric ED usage that are associated with future ED visits for violent injuries.
Methods:
This case-control study included youths aged 6 to 19 years who presented to a pediatric ED over a 3-year period due to a physical assault (PA) or their first known gunshot wound (GSW). We compared them with age-, race-, and sex-matched youths presenting for nonviolent medical complaints. All previous ED visits were coded as (1) injuries due to a previous PA, (2) mental/behavioral health visits, (3) sexual/reproductive health visits, (4) sexual assault, or (5) concerns for child abuse. We used multivariate logistic regression to identify patterns of previous ED usage associated with future ED visits for injuries related to PA and/or GSW.
Results:
The PA and GSW groups used the ED for previous PAs, mental/behavioral health, sexual/reproductive health, sexual assault, and/or child abuse concerns on average 4 to 8 times as often as the control group. Previous ED visits for mental/behavioral health (odds ratio [OR] 5), sexual/reproductive health (OR 3), sexual assault (OR 9), and prior PA (OR 8) were predictive of a future ED visit for PA. Male sex (OR 6) and previous ED visits for PA (OR 5) were predictive of a future ED visit for GSW. Two percent of the PA group and 9% of the GSW group returned to the ED with a subsequent GSW in the following 16 to 40 months.
Conclusions:
Emergency department visits due to interpersonal violence, mental/behavioral health, sexual/reproductive health, and sexual assault are associated with recurrent ED visits for violent injuries. Awareness of patterns of ED usage may aid in identifying patients at high risk for violence and increase opportunities for preventative interventions.
