Firearm violence among high-risk emergency department youth after an assault injury

Abstract

Background: The risk for firearm violence among high-risk youth after treatment for an assault is unknown.

Methods: In this 2-year prospective cohort study, data were analyzed from a consecutive sample of 14- to 24-year-olds with drug use in the past 6 months seeking assault-injury care (AIG) at an urban level 1 emergency department (ED) compared with a proportionally sampled comparison group (CG) of drug-using nonassaulted youth. Validated measures were administered at baseline and follow-up (6, 12, 18, 24 months).

Results: A total of 349 AIG and 250 CG youth were followed for 24 months. During the follow-up period, 59% of the AIG reported firearm violence, a 40% higher risk than was observed among the CG (59.0% vs. 42.5%; relative risk [RR] = 1.39). Among those reporting firearm violence, 31.7% reported aggression, and 96.4% reported victimization, including 19 firearm injuries requiring medical care and 2 homicides. The majority with firearm violence (63.5%) reported at least 1 event within the first 6 months. Poisson regression identified baseline predictors of firearm violence, including male gender (RR = 1.51), African American race (RR = 1.26), assault-injury (RR = 1.35), firearm possession (RR = 1.23), attitudes favoring retaliation (RR = 1.03), posttraumatic stress disorder (RR = 1.39), and a drug use disorder (RR = 1.22).

Conclusions: High-risk youth presenting to urban EDs for assault have elevated rates of subsequent firearm violence. Interventions at an index visit addressing substance use, mental health needs, retaliatory attitudes, and firearm possession may help decrease firearm violence among urban youth.

Trial registration: ClinicalTrials.gov NCT01152970.

Keywords: emergency department; firearms; youth violence.

Copyright © 2015 by the American Academy of Pediatrics.

Figures

FIGURE 1

Flint Youth Injury Study Flowchart (December 2009–September 2011). * Assault-injured patients seeking care not during recruitment shifts, n = 319 (18.6%); only 18.6% of assault injured youth sought ED care during a time when RA was not present. ** See Methods for details. STD, sexually transmitted disease.

FIGURE 2

Percent of respondents in follow-up sample reporting firearm violence by cohort assignment at 6-month intervals. * Indicates significant difference between groups at the .05 level.