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Hospital-based violence intervention programs in the United States and Canada: A systematic review, meta-analysis,
Randeep Jawa1, John J Como, Julia Coleman
1Department of Surgery, Stony Brook Medicine, Stony Brook, NY (R.J.); Department of Surgery, MetroHealth Medical Center, Cleveland, OH (J.Como); Department of Surgery, The Ohio State University, Columbus, OH (J.Coleman); Department of Surgery, Lahey Clinic Burlington, MA (C.N.); Department of Surgery, Medical College of Wisconsin, Milwaukee, WI (P.M.); Department of Surgery, Mercy Hospital (L.S.); Department of Surgery, University of California Irvine, Irvine, CA (S.B.); Department of Surgery, University of Maryland, Baltimore, MD (S.G.); Population Health Research Institute, MetroHealth Medical Center, Cleveland, OH (S.L.); Department of Surgery, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH (M.C.).
Background:
Interpersonal violence is one of the leading causes of death and disability. Hospital-based violence intervention programs (HVIPs) have been employed to address the psychosocial, educational, mental health, and other needs of injured patients. The objective of this systematic review and meta-analysis was to evaluate the impact of HVIPs in the United States or Canada on violent injury recidivism.
Methods:
US or Canadian studies with clearly defined adult-only or adult-and-pediatric patient populations were analyzed to evaluate the efficacy of HVIPs (intervention) compared with no HVIPs (comparator) in preventing violent reinjury recidivism (outcomes). A systematic literature search and review was conducted, and the quality of evidence was evaluated per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. We performed a meta-analysis with leave-one-out sensitivity analysis of studies meeting criteria for quantitative assessment.
Results:
Seventeen studies met our selection criteria and were included in the qualitative analysis, including one subgroup study. Of these, 10 studies were included in a meta-analysis, with results favoring HVIP programs (OR, 0.60; 95% CI, 0.38-0.94; Cochran's Q p=0.0025) for the prevention of violent injury recidivism. Overall evidence quality was deemed to be low, with substantial heterogeneity (I² = 64.7%) between studies.
Conclusions:
We conditionally recommend HVIP programs in urban trauma centers with substantive violent injury in adult-only or mixed adult-pediatric populations in the United States or Canada for the prevention of violent injury recidivism, with centers evaluating program design and benefit locally. Given the heterogeneity of reported results and program offerings, we also recommend continuing research on this topic, with the creation of a standard definition of HVIP programs and outcomes of interest. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).
Level Of Evidence:
Systematic Review with Meta-Analysis; Level IV.
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