Nav: Home

Predicting a patient's future firearm violence risk in the emergency department

April 12, 2017

ANN ARBOR, Mich. - Homicide is the third-leading cause of death among young people ages 15 to 24. More than 87 percent of those homicides are due to firearms, according to the Centers for Disease Control and Prevention.

"Firearm violence is a public health problem," says Jason Goldstick, Ph.D., assistant professor of research in emergency medicine at Michigan Medicine. "At-risk youth may not have many ways to connect to violence-prevention services. This means the emergency department is a critical access point for identifying youth that are most at risk and intervening to hopefully decrease their risk of future firearm violence."

Goldstick is the lead author of a new study based on a secondary analysis of data from a study funded by the National Institute on Drug Abuse. It's published in Annals of Internal Medicine, and it sought to provide emergency department physicians with a new clinical risk index tool to gauge firearm violence risk among urban youth.

"If we have some indication of which of these young people are at high risk, then perhaps this could guide emergency physicians on what to do next in terms of referring them to prevention resources," Goldstick says.

Collecting data through questionnaires

Goldstick and team reviewed previous screening tools for youth violence but noted they were primarily focused on primary care settings, lacked a specific focus on firearm violence and were too lengthy for practical use in the hectic emergency department setting.

The researchers examined data collected during the Flint Youth Injury study, led by Rebecca Cunningham, M.D., professor of emergency medicine at Michigan Medicine and senior author on the new study with Goldstick. The Flint Youth Injury study was a two-year cohort of patients ages 14 to 24 who reported drug use in the past six months and sought care at a Level 1 trauma center in Flint, Michigan. The study compared patients who were injured in assaults versus those seen for other emergency care. Although the study took place at a single site, the research team noted that Flint has rates of violence similar to other midsize urban centers, such as Youngstown, Ohio; Camden, New Jersey; and Oakland, California.

In total, 599 youth took a self-reported survey of 115 items with questions on such topics as violence involving partners and peers, community violence exposure, alcohol and drug use and peer influences. Participants were compensated for follow-up assessments at six, 12, 18 and 24 months.

Of the group, 483 youth (80.6 percent) could be definitively classified in terms of their involvement in firearm violence during the follow-up period. The remaining 19.4 percent were unable to be classified because of missing data.

Of the 80.6 percent, 52.2 percent indicated they had been involved in firearm violence.

"We randomly split the data into a training set and a validation set with prevalence of firearm violence equivalent in each," Goldstick says. "Using only training data, we used a machine-learning classification approach to identify the most predictive factors for future firearm violence."

He adds, "Those factors fell predominantly into four domains: peer and partner violence victimization, community violence exposure, peer/family influences and fighting. Choosing one item from each domain -- serious fighting frequency, number of friends that carry weapons, frequency of hearing gunshots in your neighborhood and frequency of received firearm threats -- we created a 10-point score and demonstrated its predictive power on the validation data."

The created score is named SaFETy, a mnemonic for remembering the four items: Serious fighting, Friend weapon-carrying, community Environment and firearm Threats.

Future use

Goldstick says this new tool could be useful for emergency physicians.

"Before this tool, there was no clear way to gauge risk of future firearm violence," he says. "We know that someone presenting to the emergency department with a violent injury is at elevated risk, but the SaFETy score shows superior predictive power than just knowing they were treated for a violent injury."

Goldstick and team realize this new index was developed using a high-risk sample and may not apply to every patient population.

Goldstick hopes emergency physicians practicing in urban centers find the SaFETy score useful.

"Predicting gun violence isn't easy to do," he says. "But we hope the index could help emergency physicians prospectively determine the highest-risk individuals and use that to tailor preventative services. Resources are scarce for prevention, and the more we can tailor services depending on level of risk, the more efficiently they can be allocated."
-end-


Michigan Medicine - University of Michigan

Related Violence Articles:

Where climate change is most likely to induce food violence
While climate change is expected to lead to more violence related to food scarcity, new research suggests that the strength of a country's government plays a vital role in preventing uprisings.
New study shows youth violence on decline
Contrary to popular perception, a new study by Boston University professor Christopher Salas- Wright finds that youth violence is declining -- and at noteworthy rates.
Self-harm linked to violence towards others
There is a link between self-harm and the risk of violent criminality, according to a Swedish registry study carried out by researchers at Karolinska Institutet and published in the scientific journal JAMA Psychiatry.
Join forces to reduce US violence, says UK expert
Violence in the US can be reduced if police and health agencies join forces, says a leading UK expert.
Reducing severe violence among adolescents
A special section of the journal Child Development includes new research exploring severe youth violence.
The connection between child marriage and domestic violence
A new study published in the International Journal of Epidemiology indicates that women across 34 countries are at increased risk for domestic violence if they marry before age 15.
Tampon makers could help reduce violence against women
Manufacturers of feminine hygiene products, including tampons and sanitary products, could dedicate a part of their revenues to support public health programmes that prevent violence against women, argues an expert in The BMJ this week.
Conference on gender and social violence
An international conference entitled A gender prospective on social violence will be held in Rome, Italy on Tuesday 21 June.
Is firearm violence greater among the mentally ill?
A new study finds that the majority of mental health professionals believe firearm safety issues are greater among mentally ill people, yet they do not screen their clients for firearms or provide firearm safety counseling.
Are money problems and violence related?
University of Iowa researchers find an association between financials stress and severe domestic abuse, but the discovery doesn't prove one leads to the other.

Related Violence Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#530 Why Aren't We Dead Yet?
We only notice our immune systems when they aren't working properly, or when they're under attack. How does our immune system understand what bits of us are us, and what bits are invading germs and viruses? How different are human immune systems from the immune systems of other creatures? And is the immune system so often the target of sketchy medical advice? Those questions and more, this week in our conversation with author Idan Ben-Barak about his book "Why Aren't We Dead Yet?: The Survivor’s Guide to the Immune System".