Emergency Department Usage Patterns Among Pediatric Victims of Gun Violence and Physical Assault

Objective: Violent injuries are a common reason for pediatric emergency department (ED) visits, with gun violence being the leading cause of violent death among children. The objective of this studywas to assess for patterns of pediatric ED usage that are associated with future ED visits for violent injuries. Methods: This case-control study included youths aged 6 to 19 years who presented to a pediatric ED over a 3-year period due to a physical assault (PA) or their first known gunshot wound (GSW).We compared them with age-, race-, and sex-matched youths presenting for nonviolentmedical complaints. All previous ED visits were coded as (1) injuries due to a previous PA, (2)mental/behavioral health visits, (3) sexual/reproductive health visits, (4) sexual assault, or (5) concerns for child abuse.We used multivariate logistic regression to identify patterns of previous ED usage associated with future ED visits for injuries related to PA and/or GSW. Results: The PA and GSWgroups used the ED for previous PAs, mental/ behavioral health, sexual/reproductive health, sexual assault, and/or child abuse concerns on average 4 to 8 times as often as the control group. Previous ED visits for mental/behavioral health (odds ratio [OR] 5), sexual/ reproductive health (OR 3), sexual assault (OR 9), and prior PA (OR 8) were predictive of a future ED visit for PA. Male sex (OR 6) and previous ED visits for PA (OR 5) were predictive of a future ED visit for GSW. Two percent of the PA group and 9%of the GSWgroup returned to the EDwith a subsequent GSWin the following 16 to 40 months. Conclusions: Emergency department visits due to interpersonal violence, mental/behavioral health, sexual/reproductive health, and sexual assault are associated with recurrent ED visits for violent injuries. Awareness of patterns of ED usage may aid in identifying patients at high risk for violence and increase opportunities for preventative interventions.