Risk for Future Firearm Violence in High-Risk Youth

Katherine Bakes, MD reviewing Carter PM et al. Pediatrics 2015 Apr 6.

Over half of youth presenting to an urban ED and reporting recent drug use experienced firearm violence within the next two years.

In a prospective study of youth (aged 14–24 years) presenting to a Flint, Michigan, emergency department (ED) and reporting recent drug use (within the past 6 months), investigators evaluated the risk for future firearm violence. A total of 349 patients with assault injuries and 250 age- and sex-matched patients who presented for other reasons were evaluated every 6 months for 24 months; about 80% completed follow-up.

During the follow-up period, 252 patients (52%) reported firearm violence; there was an average of eight incidents, most within the first 6 months. Among those reporting firearm violence, 96% were victims (threatened with a gun or shot at), 32% were aggressors, 8% required ED care for firearm injuries, and two died from firearm injuries. In addition, 56% met diagnostic criteria for a recent mental health illness.

Regression analysis revealed the following predictors of future firearm violence: male sex (relative risk, 1.5), assault-related initial ED presentation (RR, 1.4), post-traumatic stress disorder (RR, 1.4), African-American race (RR, 1.3), firearm possession (RR, 1.2), drug abuse or dependence (RR, 1.2), and retaliatory attitudes (RR, 1.03).

Given that youth firearm homicide rates are 43 times higher in the U.S. than in similarly developed nations, the authors advocate for hospital-based violence intervention strategies and call for “novel public policies” to prevent access to illegal weapons among high-risk youth.

CITATION(S):

Carter PM et al. Firearm violence among high-risk emergency department youth after an assault injury. Pediatrics 2015 Apr 6; [e-pub].