Risk for Repeat Emergency Department Visits for Violent Injuries in Youth Firearm Victims

Hyun Ja Lim1, Michael McCart2, W Hobart Davies3, Alice Calhoun4 and Marlene D. Melzer-Lange51Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada. 2Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Avenue, Charleston, South Carolina, U.S.A. 3Department of Psychology, University of Wisconsin-Milwaukee, 2200 E. Kenwood Blvd. Milwaukee, Wisconsin, U.S.A. 4Valley Children's Hospital, 9300 Valley Children's Place, Madera, California, U.S.A. 5Section of Emer- gency Medicine, Department of Pediatrics, Medical College of Wisconsin, 9000 W. Wisconsin Avenue Milwaukee, Wisconsin, U.S.A.AbstractObjective: To identify significant risk factors associated with repeat emergency department (ED). Visits for violent injuries in youth fi rearm victims.Methods: The study subjects of this retrospective cohort study were fi rearm victims aged 18 and younger presenting to a Pediatric Emergency Department/Trauma Center at Children's Hospital of Wisconsin between 1990 and 1995. The primary outcome was subsequent Emergency Department visits (REDV) at any emergency department in Milwaukee for a violent injury.Results: A total of 495 subjects were eligible for the present study in the pediatric fi rearm victim's ED visit database. Eighty-five percent (n = 420) were males and 82% were African-Americans. Mean age was 15 years old (s.d = ±3.6). A majority of them had a single-parent family. Eighty-eight subjects (17.8%) had a prior history of ED visit due to violence. During the study time, 201 subjects had at least one REDV. In the multivariable model, a subject without a social worker consulting at the hospital were more likely to have REDV compared to subjects with a social worker consulting (O.R = 1.749; p-value = 0.047), controlling for guardian and disposition. Subjects disposed to detention center or police custody were more likely to have REDV compared to subjects disposed to home or a hospital (O.R = 5.351; p-value = 0.003).Conclusion: Our analysis indicates that individuals with guardians, those who did not receive social worker intervention on their initial visit, and those discharged in police custody were associated with increased repeat ED visits due to a violent injury.