Emergency Department Utilization Among Assault-Injured Youth

Abstract

Assault is a common cause of youth emergency department (ED) visits. Little is known about prior ED utilization patterns among assault-injured youth. This study's objectives were to determine whether, and how, prior ED visit history distinguishes assault-injured youth from unintentionally injured youth. A 5-year retrospective, case-control study was conducted using a hospital billing database. Youth ages 13 to 24 years presenting to the ED of an urban level 1 trauma center in 2011 with an E-code of physical assault- or weapon-related injuries were compared 1:1 to randomly assigned, age- and sex-matched controls with an E-code corresponding to unintentional injury. Bivariate, t test, Wilcoxon rank sum tests, and conditional logistic regression were performed to determine how previous ED visits distinguished assault-injured youth from unintentionally injured youth. In 2011, 964 patients presented with assault-related injuries. Over the previous 5 years, assault-injured youth had a median of 1 prior ED visit (interquartile range, 0-3); unintentionally injured youth had a median of zero prior ED visits (interquartile range, 0-2). Assault-injured youth had significantly higher median numbers of previous psychiatric and assault-related ED visits when compared to unintentionally injured youth. A youth with 1 previous psychiatric ED visit had a 4-fold increased odds (adjusted odds ratio [AOR], 4.05; 95% confidence interval, 2.41-6.83) of having a 2011 assault-related ED visit compared to unintentionally injured youth. Assault-injured youth are more likely to have had prior ED use particularly for psychiatric illnesses and assault-related injury. Targeted youth violence screening may be appropriate for such patients.