369 Recidivism Among Young Gunshot Victims: Analysis of Outcomes from CeaseFire New Orleans

Abstract

New Orleans has both one of the nation’s highest per capita murder rates and a population served by a single trauma center, University Medical Center (UMC). Since January 2014, CeaseFire New Orleans has employed a Hospital Crisis Intervention Team at UMC to respond 24/7 to shootings involving victims ages 16 to 25 years old. Hailing from the same communities as those most impacted by violent crime, CeaseFire staff interfaces with victims and their families in a culturally competent manner to prevent retaliatory violence. They also provide educational, employment, and mental health support to victims in an effort to break the cycle of violence. This study assesses the early impact of the CeaseFire New Orleans program, focusing on individual patient outcomes such as recidivism for major gunshot wounds (GSW). A retrospective study of GSW victims was conducted using UMC trauma registry data from 2010-2017, focusing on men age 16 to 25 years old. We matched CeaseFire encounter forms to the trauma registry data to create 3 cohorts for the time period 2014-2017: those who accepted CeaseFire support and became program participants, those who were offered CeaseFire program participation but declined, and those not offered the intervention. Propensity score matching was used to minimize confounding variables among the groups. Additionally, we analyzed the groups from the perspective of having been a GSW victim prior to their index visit during the study period, and examined recidivism rates during the study period. Finally, we used survival analysis to evaluate the time to recidivism events. From 2010-2017, UMC saw 4197 patients with violent penetrating trauma; 2877 sustained major GSWs, of which 47.1% were 16 to 25 years old. In that age group, 89.8% were male and 95.8% were black. Within the study period, 8.8% of this age group had a recidivism event, compared with 6.6% for victims of all ages. From 2014-2017, CeaseFire enrolled 76 participants; 314 were offered the intervention and declined, and 161 were not offered the intervention. Recidivism rates among the 3 groups were roughly similar in the time period studied. Further analysis revealed that the CeaseFire participant group trended towards higher rates of GSWs suffered before the study index visit when compared to other groups, but their post-CeaseFire enrollment recidivism rates decreased to the overall group mean. Furthermore, participants had a mean 805 days (67 months) until a recidivism event if it occurred, compared with 682 days for those who declined the intervention and 693 days for those not offered the intervention (both 57 months). CeaseFire appropriately targets the largest age demographic for major GSWs in New Orleans. This group was found to have a high incidence of GSWs prior to their index visit, as well as subsequent recidivism. Although recidivism rates in the intervention group were not significantly different than the other 2 groups, those in the intervention group who had a repeat major GSW had a longer time period until the event. As a preliminary assessment of the program, this data suggests promise of the CeaseFire New Orleans model, provides a temporal opportunity for further risk mitigation in this extremely high-risk population, and can guide continued implementation of the program. Further long-term studies are needed.