Improving Targeted Violence Prevention Programs Can Reduce ER Uilization

Preventing recurrent violent injury has always been an important component of public health approach to interpersonal violence. It has also been the prime focus of violence intervention programs. However, prior studies have done very little to highlight the true incidence of recurrent violent injury.

New research on recurrent violent injuries, its costs, and risk factors found that approximately 1 in 9 people sent to emergency rooms (ERs) for violent injuries in 2010 ended up being violently injured again within 2 years. The study was conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania and the findings are published in the American Journal of Emergency Medicine.

“While violence prevention programs in trauma centers have been shown to be effective, recurrent violent injury is still very common and very costly,” lead author Elinore Kaufman, MD, a resident in General Surgery at New York-Presbyterian/Weill Cornell Medical Center in New York, said in a statement. “We need to be doing more to make sure every patient has the resources they need to stay safe.”

Interpersonal violence led to more than 16,000 deaths, 140,000 hospitalizations, and 1.6 million ER visits in 2010, according to CDC. The medical costs for treating and preventing such incidences was an estimated $8.5 billion. While hospitals have focused on intervention programs to prevent recurrences among victims, the new research establishes more opportunities for intervention based on a statewide analysis.

Study Findings

The authors examined ER-reported injuries from interpersonal violence for Florida. All visits during 2010 and recurrent visits within 2 years were recorded. It was found that out of approximately 54,000 patients admitted to ERs for violent injuries in 2010, 11% returned with a new violent injury at least once within the next 2 years. At least 20% of these patients had 2 or more recurrences, with many injuries classifying as “severe.” These initial and recurrent ER visits amounted to a whopping $596 million in medical charges.

Other findings included:

• Medicaid and uninsured patients had twice the rate of recurrent injuries as compared to other patients.
• Homeless patients made up for a disturbing majority of initial injury victims. They were also 60% more likely to experience recurrent injuries, compared to non-homeless.
• African Americans also made up a disproportionately high percentage of initial injury victims. They were 10% more likely than whites to return with injuries.
• The male-female ratio of recurring injuries was similar. However, men were 70% more likely to return with “severe” injuries.
• Patients with history of mental illness or alcohol abuse had a much higher rate of violent injury recurrence than those with no such history.

Understanding the Risk Factors

Recurrent violent injury is a common and costly phenomenon. For effective violence prevention programs, understanding the risk factors could be the key.

Risk factors for recurrent violent injury included homelessness, residence in low income neighborhoods, and history of mental illness or alcohol abuse. Low income, homelessness, Medicaid or uninsurance, and black race were associated with increased odds of recurrence.

“These findings can serve as a baseline for interventions aimed at reducing recurrence,” Kaufman said. “Our findings also highlight the potential for housing stability, behavioral health and substance abuse programs to break cycles of violence.”