Abstract
Purpose
We aim to describe interpersonal violence-related injury patterns in the pediatric
trauma population and to identify predictors of recidivism.
Methods
In this retrospective analysis from a single institution, we included pediatric patients
(≤17 years) treated (2006–2020) for traumatic injury related to interpersonal violence
(IPV). Patient characteristics were compared among mechanism types and between recidivists
and non recidivists using two sample t-tests, Wilcoxon rank-sum tests, and Pearson's
chi-squared. Multivariate analysis was performed using logistic regression to identify
predictors of repeat injury.
Results
We identified 635 pediatric patients who sustained injuries owning to IPV: firearm
(N = 266), assault (stab/blunt; N = 243), and abuse (N = 126). The average age of the firearm, assault, and abuse groups was 15.5, 14.7,
and 1.1 years (SD = 2.2, 3.4, 2.4 years), respectively. Majority of the overall cohort
was male (77.5%) and publicly- or un insured (67.8%), with 28.0% being Black. Of the
489 firearm and assault patients who survived the first injury, 30 (6.1%) had repeat
injury owning to IPV requiring treatment at our center with a median time of 40 months
(IQR 17-62 months) between first and second injury. The majority of recidivists (83.3%)
were victims of gun violence whereas the distribution between assault and firearm
in the non recidivists was more even at 51 and 49%, respectively (p < 0.001). Eighteen (60.0%) of the recidivist patients had the same mechanism between
the first and second injury. In the logistic regression analysis, Black race and firearm
injury were associated with greater than 3-fold higher likelihood of repeat injury
compared to white race after adjusting for age, sex, insurance, and child opportunity
index.
Conclusions
We found that survivors of firearm injuries and assault comprise a vulnerable patient
cohort at risk for repeat injury, and Black race is an independent predictor of repeat
injury owning to IPV. These findings provide guidance for developing violence prevention
programs.
Type of study
Retrospective Comparative Study
Level of evidence
Level III
Keywords
Abbreviations:
IPV (interpersonal violence), ED (emergency department), COI (child opportunity index), ISS (injury severity score)To read this article in full you will need to make a payment
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References
WISQARS Database Query. Centers Disease Control and Prevention National center for injury prevention and control 2021. https://www.cdc.gov/injury/wisqars/index.html (accessed March 9, 2022).
- What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review.J Behav Med. 2019; 42: 724-740https://doi.org/10.1007/s10865-019-00035-2
- Twenty years of pediatric gunshot wounds in our community: have we made a difference?.J Pediatr Surg. 2019; 54: 160-164https://doi.org/10.1016/j.jpedsurg.2018.10.003
- Factors associated with pediatric firearm injury and enrollment in a violence intervention program.J Pediatr Surg. 2021; 56: 754-759https://doi.org/10.1016/j.jpedsurg.2020.06.025
- The role of neighborhood income inequality in adolescent aggression and violence.J Adolesc Heal. 2014; 55: 571-579https://doi.org/10.1016/j.jadohealth.2014.04.012
- Youth and young adult victims of interpersonal violence at La County + USC medical center: a review of epidemiology and recidivism.Am Surg. 2019; 85: 1166-1170https://doi.org/10.1177/000313481908501020
- Violent trauma recidivism: does all violence escalate?.Eur J Trauma Emerg Surg. 2018; 44: 851-858https://doi.org/10.1007/s00068-017-0787-5
- Pediatric trauma recidivism in an urban cohort.J Surg Res. 2013; 182: 326-330https://doi.org/10.1016/j.jss.2012.12.007
- Violent reinjury and mortality among youth seeking emergency department care for assault-related injury: a 2-year prospective cohort study.JAMA Pediatr. 2015; 169: 63-70https://doi.org/10.1001/jamapediatrics.2014.1900
- Mentoring pediatric victims of interpersonal violence reduces recidivism.J Interpers Violence. 2020; 35: 4262-4275https://doi.org/10.1177/0886260517705662
- An integrated public health approach to interpersonal violence and suicide prevention and response.Public Health Rep. 2018; 133: 65S-79Shttps://doi.org/10.1177/0033354918800019
- Racial and ethnic inequities in children's neighborhoods: evidence from the new child opportunity index 2.0.Health Aff. 2020; 39: 1693-1701https://doi.org/10.1377/hlthaff.2020.00735
Child opportunity index 2.0 database. DiversitydatakidsOrg 2022.
- An analysis of pediatric social vulnerability in the Pennsylvania trauma system.J Pediatr Surg. 2020; 55: 2746-2751https://doi.org/10.1016/j.jpedsurg.2020.05.024
- Neighborhood socioeconomic status is associated with violent reinjury.J Surg Res. 2015; 199: 177-182https://doi.org/10.1016/j.jss.2015.03.086
- The child opportunity index and disparities in pediatric asthma hospitalizations across one Ohio metropolitan area, 2011–2013.J Pediatr. 2017; 190 (e1): 200-206https://doi.org/10.1016/j.jpeds.2017.08.007
- Neighborhood child opportunity and individual-level pediatric acute care use and diagnoses.Pediatrics. 2018; 141https://doi.org/10.1542/peds.2017-2309
The Annie E. Casey Foundation. Under 18 child population by race/ethnicity in King. KIDS COUNT Data Cent n.d. https://datacenter.kidscount.org accessed June 11, 2022.
- Race and ethnicity, neighborhood poverty and pediatric firearm hospitalizations in the United States.Ann Epidemiol. 2016; 26 (e2): 1-6https://doi.org/10.1016/j.annepidem.2015.10.009
- Individual and neighborhood characteristics of children seeking emergency department care for firearm injuries within the PECARN network.Acad Emerg Med. 2017; 24: 803-813https://doi.org/10.1111/acem.13200
- Pediatric gunshot wound recidivism.J Trauma Acute Care Surg. 2016; 80: 877-883https://doi.org/10.1097/TA.0000000000001072
- Hospital-centered violence intervention programs: a cost-effectiveness analysis.Am J Surg. 2015; 209: 597-603https://doi.org/10.1016/j.amjsurg.2014.11.003
- Benefits of a hospital-based peer intervention program for violently injured youth.J Am Coll Surg. 2007; 205: 684-689https://doi.org/10.1016/j.jamcollsurg.2007.05.029
- The effectiveness of an ED-based violence prevention program.Am J Emerg Med. 2006; 24: 8-13https://doi.org/10.1016/j.ajem.2005.05.009
- Effectiveness of a mentor-implemented, violence prevention intervention for assault-injured youths presenting to the emergency department: results of a randomized trial.Pediatrics. 2008; 122: 938-946https://doi.org/10.1542/peds.2007-2096
- Brief violence interventions with community case management services are effective for high-risk trauma patients.J Trauma Inj Infect Crit Care. 2011; 71: 228-237https://doi.org/10.1097/TA.0b013e31821e0c86
- A case for risk stratification in survivors of firearm and interpersonal violence in the urban environment.West J Emerg Med. 2020; 21: 132-140https://doi.org/10.5811/WESTJEM.2020.8.45041
Article info
Publication history
Published online: September 24, 2022
Accepted:
September 15,
2022
Received:
August 26,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
