Risk of a Subsequent Visit for an Assault-related Injury Among Injured Youth in a Pediatric Emergency Department

Background: Violent injuries are a significant public health concern in the United States. Assault-injured youth seeking care in the emergency department (ED) report higher levels of previous violence, weapon exposure, and substance use compared with children seeking care for other complaints. There have been few studies specifically investigating how ED use changes among youth after an assault versus a visit for non-assaultive injury. The objective of this study was to measure and compare the risk of a subsequent assault-related ED visit in assault injury patients versus those who initially presented for non-assault related injuries.

Methods: This was a retrospective cohort study of youth (ages 10-18 years) at two pediatric EDs between 2016 and 2019. Participants were included if their visit had an ICD code for assaultive injury or accidental injury (motor vehicle collisions (MVC) and sports injuries). We described our study sample and calculated the rate of a subsequent ED visit for an assault related injury. We then generated adjusted hazard ratios (aHR) and Kaplan-Meier survival curves to compare time to subsequent visit with an assault-related injury between study and comparison groups.

Results: 6125 adolescents presented to the ED for an initial visit (Assault: n=2782, 45.4%;, MVC: n=1834, 29.9%;, Sports related injury n=1509, 24.6%). The overall rate of return for a subsequent ED visit for an assault related injury was 5.62% (n=344). Patients who initially presented with assault had an increased aHR of return for a subsequent ED visit for an assault-related injury when compared to MVC patients (17.70 (9.67, 32.42)). We did not observe a difference when we compared sports related injury to MVC (0.49 (0.16, 1.54)).

Conclusion: Assault injured youth are more likely to return to the ED for a subsequent assault related injury in comparison to youth who were initially injured in a MVC or during sports. This is consistent with previous work suggesting that previous episodes of violence are the strongest predictor of future violent injuries. Results from this study support the need for ED based violence prevention initiatives that target high-risk youth before and after acute injury.