Refining tools that identify the risk of violence among young adults in urban emergency rooms could save lives

Half of young adult patients treated in the emergency rooms of three urban hospitals across the country reported experiencing violence as a victim or aggressor, including gun violence, in the six months prior to seeking treatment, according to a study from the University of Michigan.

Researchers examined and documented the experiences of more than 1,500 patients ages 18 to 24 who entered Level 1 trauma centers in Philadelphia, Seattle and Flint, Michigan, between July 2021 and May 2023. While half of patients said they had experienced some form of violence, about 14% specifically reported threats with firearms or shootings, either as victims or as aggressors, and 6% reported being shot or shooting someone else.

The findings are published in the news Preventive medicine.

The study went beyond questions about violence and found that substance abuse, mental health symptoms, carrying firearms, violence or retaliation, family conflict and prosocial behavior aimed at helping or benefiting others were associated with gun attacks. Additionally, more than half of participants self-reported risky substance use and screened positive for post-traumatic stress disorder and depression or anxiety, or both – higher than that of the general population.

These are all factors to consider when screening for future violence, the researchers say.

“These findings update previous ED-based violence epidemiology studies and suggest that there are other important factors associated with the experience of firearm assaults,” said Jason Goldstick, associate professor of emergency medicine and co-director of the Institute for Firearm Injury Prevention's Data and Methods from UM. Core.

Urban emergency departments can be a vital point of contact for youth at risk of violence, according to the study, which cites previous research showing that youth who receive emergency care for violence-related injuries are at significant risk for violent re-injury, with more than a third returning within two years. Nearly a quarter of those who received emergency care for other reasons returned within a year.

“Our results highlight other important service needs of young adults entering the emergency department,” Goldstick said. “Taken together, these new data demonstrate that it is possible to characterize those at greatest risk and use that information to inform intervention development and distribute resources efficiently.”

The study, part of the SPARK (Screening to Predict Young Adults at Risk for Firearm Violence) project, was led by researchers from the UM Institute for Firearm Injury Prevention. SPARK seeks to evaluate the impact and effectiveness of the SaFETy score, a screening tool used in emergency departments to predict future risk of gun violence.

The SaFETy (Serious Fighting, Friend Weapon Carrying, Community Environment and Firearm Threats) score was developed at UM and is the only resource of its kind. It uses four items and a 10-point scale to specifically identify the risk of gun violence among young adults and youth: 1) frequency of fighting behavior, 2) number of friends carrying guns, 3) frequency of hearing gunshots in their neighborhood and 4) frequency of threats of gun violence

“Violence, including gun attacks, is common among young adults entering urban emergency departments and is associated with several psychosocial factors,” Goldstick said. “High rates of substance use and mental health symptoms highlight this as a population with high needs. Using this information, interventions can be tailored and resource allocation optimized.”