Screening for violence risk factors identifies young adults at risk for return emergency department visit for injury.
Screening for violence risk factors identifies young adults at risk for return emergency department visit for injury.
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DOI：
10.5811/westjem.2014.4.21275
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发表时间：
2014-08
期刊：
影响因子：
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通讯作者：
Houry D
中科院分区：
文献类型：
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作者：
Hankin A;Wei S;Foreman J;Houry D
他杀是15-24岁年轻人的第二大死因。以前的横断面研究，在非医疗保健环境中，报告了暴露于社区暴力、同伴行为和犯罪是暴力伤害的风险因素。然而，还没有进行纵向队列研究来评估这些危险因素与高危青少年中因受伤而去急诊科就诊之间的时间或预测关系。目的是评估年轻人自我报告的暴露于暴力危险因素是否可以用来预测未来一年内因伤害而去急诊室就诊的情况。这项前瞻性队列研究是在美国东南部I级创伤中心的急诊室进行的。符合条件的参与者是年龄在18-24岁之间的患者，任何主诉都会出现。我们排除了危重、被监禁或不懂英语的患者。最初的招聘为期6个月，由教育署的一名研究助理每周3-5天，安排轮班，包括周末和工作日，时间从上午8点到晚上8点在首次接触急诊室时，患者被要求完成一份书面问卷，其中包括以前经过验证的工具，衡量以下危险因素：a)攻击性，b)感知的暴力可能性，c)最近的暴力行为，d)同伴行为，e)社区暴露于暴力，和f)积极的未来前景。在首次急症室就诊12个月后，对参与者的医疗记录进行审查，以确定随后是否有与伤害有关的投诉就诊。数据分析采用卡方检验和Logistic回归分析。访问了332名患者，其中300名患者表示同意。参与者的平均年龄为21.1岁，其中60.1%为女性，86.0%为非裔美国人。在控制了第一次就诊时参与者的性别、种族或受伤投诉后，伤害的回访与以下因素显著相关：敌对/攻击性感觉(优势比(OR)3.5，95%可信区间(CI)：1.3，9.8)，自我报告的暴力可能性(OR 10.1，95%CI：2.5，40.6)，以及同龄人群体暴力(OR 6.7，95%CI：2.0，22.3)。对暴力风险因素的简要调查预示着因受伤而再次前往急诊室就诊的可能性增加。这些发现确定了一种潜在的重要工具，用于初步预防高危青少年的暴力伤害，这是教育署关于创伤相关和非创伤投诉的一种工具。
Homicide is the second leading cause of death among youth aged 15–24. Prior cross-sectional studies, in non-healthcare settings, have reported exposure to community violence, peer behavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies have not been performed to evaluate the temporal or predictive relationship between these risk factors and emergency department (ED) visits for injuries among at-risk youth. The objective was to assess whether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period. This prospective cohort study was performed in the ED of a Southeastern US Level I trauma center. Eligible participants were patients aged 18–24, presenting for any chief complaint. We excluded patients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurred over a 6-month period, by a research assistant in the ED for 3–5 days per week, with shifts scheduled such that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initial contact in the ED, patients were asked to complete a written questionnaire, consisting of previously validated instruments measuring the following risk factors: a) aggression, b) perceived likelihood of violence, c) recent violent behavior, d) peer behavior, e) community exposure to violence, and f) positive future outlook. At 12 months following the initial ED visit, the participants' medical records were reviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chi-square and logistic regression analyses. Three hundred thirty-two patients were approached, of whom 300 patients consented. Participants' average age was 21.1 years, with 60.1% female, 86.0% African American. After controlling for participant gender, ethnicity, or injury complaint at time of first visit, return visits for injuries were significantly associated with: hostile/aggressive feelings (Odds ratio (OR) 3.5, 95% Confidence interval (CI): 1.3, 9.8), self-reported perceived likelihood of violence (OR 10.1, 95% CI: 2.5, 40.6), and peer group violence (OR 6.7, 95% CI: 2.0, 22.3). A brief survey of risk factors for violence is predictive of increased probability of a return visit to the ED for injury. These findings identify a potentially important tool for primary prevention of violent injuries among at-risk youth seen in the ED for trauma-related and non-traumatic complaints.