Identifying participants for inclusion in hospital-based violence intervention: An analysis of 18 years of urban firearm recidivism.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
entrez:
24
6
2020
pubmed:
24
6
2020
medline:
10
9
2020
Statut:
ppublish
Résumé
Identifying individuals at highest risk maximizes efficacy of prevention programs in decreasing recidivist gunshot wound (GSW) injury. Characteristics of GSW recidivists may identify this population. Hospital-based violence intervention programs (HVIPs) are one effective strategy; however, programs are expensive, therefore, when possible, epidemiologic data should guide inclusion criteria. Seventeen years of all GSW patients presenting to an urban Level I trauma center were reviewed. Countywide murders were reviewed from the same timeframe. Recidivists were any patient presenting twice, either to the hospital or once to the hospital and subsequently dying by firearm. Demographics and characteristics of future recidivists were compared with nonfuture recidivists. There were 9,699 unique intentional, GSW cases reviewed and 1,426 died, leaving 8,273 at risk of recidivism. Five hundred fourteen (6.2%) became recidivists. Most recidivists were African-American men and were younger at first GSW. Median time between incidents was 2.5 years, with a range of 0 days to 16 years. Nearly half were treated and released from the emergency department at their first episode of GSW. For recidivists who died, 128 died at the second incident, 29 at later incidents. Mortality from a second incident of firearm injury is 10% higher than first injuries, second hospitalizations are US $5,000 more expensive, and loss of life has a societal cost of US $167 billion in this community alone. The most appropriate population for inclusion in HVIPs at our hospital are young black men. The HVIP services are needed in the emergency department to address those treated and released at first GSW. Recidivists have higher mortality, and hospitalizations are significantly more expensive at the second injury. The investment in prevention is justified and may lead to a decrease in recidivism. Therapeutic/Care Management level III.
Sections du résumé
BACKGROUND
Identifying individuals at highest risk maximizes efficacy of prevention programs in decreasing recidivist gunshot wound (GSW) injury. Characteristics of GSW recidivists may identify this population. Hospital-based violence intervention programs (HVIPs) are one effective strategy; however, programs are expensive, therefore, when possible, epidemiologic data should guide inclusion criteria.
METHODS
Seventeen years of all GSW patients presenting to an urban Level I trauma center were reviewed. Countywide murders were reviewed from the same timeframe. Recidivists were any patient presenting twice, either to the hospital or once to the hospital and subsequently dying by firearm. Demographics and characteristics of future recidivists were compared with nonfuture recidivists.
RESULTS
There were 9,699 unique intentional, GSW cases reviewed and 1,426 died, leaving 8,273 at risk of recidivism. Five hundred fourteen (6.2%) became recidivists. Most recidivists were African-American men and were younger at first GSW. Median time between incidents was 2.5 years, with a range of 0 days to 16 years. Nearly half were treated and released from the emergency department at their first episode of GSW. For recidivists who died, 128 died at the second incident, 29 at later incidents. Mortality from a second incident of firearm injury is 10% higher than first injuries, second hospitalizations are US $5,000 more expensive, and loss of life has a societal cost of US $167 billion in this community alone.
CONCLUSION
The most appropriate population for inclusion in HVIPs at our hospital are young black men. The HVIP services are needed in the emergency department to address those treated and released at first GSW. Recidivists have higher mortality, and hospitalizations are significantly more expensive at the second injury. The investment in prevention is justified and may lead to a decrease in recidivism.
LEVEL OF EVIDENCE
Therapeutic/Care Management level III.
Identifiants
pubmed: 32574483
doi: 10.1097/TA.0000000000002680
pii: 01586154-202007000-00012
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
68-73Références
Bureau of Justice Statistics. Criminal Victimization, 2018 Summary. Available at: https://www.bjs.gov/content/pub/pdf/cv18_sum.pdf Accessed December 1, 2019.
Mazza JJ, Reynolds WM. Exposure to violence in young inner-city adolescents: relationships with suicidal ideation, depression, and PTSD symptomatology. J Abnorm Child Psychol. 1999;27(3):203–213.
Fullilove MT, Heon V, Jimenez W, Parsons C, Green LL, Fullilove RE. Injury and anomie: effects of violence on an inner-city community. Am J Public Health. 1998;88(6):924–927.
Federal Bureau of Investigation. Uniform Crime Reporting Expanded Homicide Data. Available at: https://ucr.fbi.gov/crime-in-the-u.s/2018/crime-in-the-u.s.-2018/tables/expanded-homicide-data-table-8.xls Accessed November 12, 2019.
Nygaard RM, Marek AP, Daly SR, Van Camp JM. Violent trauma recidivism: does all violence escalate? Eur J Trauma Emerg Surg. 2018;44(6):851–858.
Scarlet S, Rogers SO Jr. What is the institutional duty of trauma systems to respond to gun violence? AMA J Ethics. 2018;20(5):483–491.
Bulger EM, Kuhls DA, Campbell BT, et al. Proceedings from the medical summit on firearm injury prevention: a public health approach to reduce death and disability in the US. J Am Coll Surg. 2019;229:415–430.e12.
Office of Disease Prevention and Health Promotion. Healthy People 2020. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/crime-and-violence Accessed Novemer 20, 2019.
Strong BL, Greene CR, Smith GS. Trauma recidivism predicts long-term mortality: missed opportunities for prevention (retrospective cohort study). Ann Surg. 2017;265(5):847–853.
Rosenblatt MS, Joseph KT, Dechert T, Duncan TK, Joseph DK, Stewart RM, Cooper ZR. American Association for the Surgery of Trauma prevention committee topical update: impact of community violence exposure, intimate partner violence, hospital-based violence intervention, building community coalitions and injury prevention program evaluation. J Trauma Acute Care Surg. 2019;87(2):456–462.
Monopoli WJ, Myers RK, Paskewich BS, Bevans KB, Fein JA. Generating a core set of outcomes for hospital-based violence intervention programs. J Interpers Violence. 2018;886260518792988.
Smith R, Dobbins S, Evans A, Balhotra K, Dicker RA. Hospital-based violence intervention: risk reduction resources that are essential for success. J Trauma Acute Care Surg. 2013;74(4):976–980. discussion 80-2.
United States Department of Labor 2016 Consumer Price Index. Available at: https://www.bls.gov/cpi/tables/variance-estimates/home.htm Accessed November 15, 2019.
FBI — UCR Publications. Available at: https://ucr.fbi.gov/ucr-publications. Accessed October 17, 2018.
Richardson JB, St Vil C, Sharpe T, Wagner M, Cooper C. Risk factors for recurrent violent injury among black men. J Surg Res. 2016;204(1):261–266.
Kao AM, Schlosser KA, Arnold MR, Kasten KR, Colavita PD, Davis BR, Sing RF, Heniford BT. Trauma recidivism and mortality following violent injuries in young adults. J Surg Res. 2019;237:140–147.
Cooper C, Eslinger DM, Stolley PD. Hospital-based violence intervention programs work. J Trauma. 2006;61(3):534–537; discussion 7-40.
Lee J, Quraishi SA, Bhatnagar S, Zafonte RD, Masiakos PT. The economic cost of firearm-related injuries in the United States from 2006 to 2010. Surgery. 2014;155(5):894–898.
Viscusi WKJJoE, Finance. How to value a life. 2008;32(4):311–323.
Livingston DH, Lavery RF, Lopreiato MC, Lavery DF, Passannante MR. Unrelenting violence: an analysis of 6,322 gunshot wound patients at a Level I trauma center. J Trauma Acute Care Surg. 2014;76(1):2–9; discussion −11.