New emergency department program 'fights' firearm-carrying youths

November 26, 2003

A new screening tool administered to adolescents seeking emergency care is effective and highly specific in predicting whether they carry firearms or not, according to a new study in the December 2003 issue of Annals of Emergency Medicine. (FiGHTS: A Preliminary Screening Tool for Adolescent Firearms-Carrying, p. 798)

"The last 15 years have provided much information on single-risk factors for firearms-carrying," said D. Neil Hayes, MD, MPH, co-author of the study. "However, adolescents who seek emergency care often have complex combinations of risk factors, and it has been impossible to sum these up in a meaningful way. We developed the FiGHTS screening tool to be used by both clinicians and researchers to help interpret complex patterns of risk-taking behavior to determine the overall probability of firearms-carrying among this age group."

The FiGHTS score, developed by Tufts New England Medical Center researchers in Boston, is a Youth Behavior Risk Survey-derived screening tool that uses known risk factors for firearms-carrying (e.g., fighting in the past year; male; hurt while fighting in the past year; threatened with a weapon at school in the past 30 days; smoker). One point is assigned for each positive response and a score of two or more is considered positive for firearms carrying.

Researchers developed both an extended FiGHTS score of 13 questions and a brief FiGHTS score of five questions, which makes up the tool's acronym (Fi=fighting, G=gender, H=hurt while fighting, T=threatened, and S=smoker).

"While this tool needs to be prospectively validated before being used widespread in emergency departments, early results indicate it may be highly useful in preventing firearm injuries among adolescents," said Dr. Hayes.

According to the study, the emergency department is the appropriate place to administer this tool because primary care screening will miss adolescents, including a majority of male adolescents who do not regularly visit a primary care physician.

"Firearms are second to motor vehicles as a leading cause of death among U.S. children between the ages of 15 and 19," said Gregory Luke Larkin, MD, MSPH, from the Departments of Emergency Medicine and Public Health and the Violence Intervention and Prevention Center at Parkland Memorial Hospital in Dallas, and author of a related editorial. "The emergency department has opportunities for youth violence surveillance and screening that are not available anywhere else. Emergency physicians must embrace firearm violence prevention as part of their practice and as an important legacy to America's children."

American College of Emergency Physicians

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