Tuesday, April 7, 2015

An Assault Injury May Lead to Subsequent Firearm Violence

By: Lewis First, MD, MS; Editor-in-Chief 
     Our heart goes out to teens who are victims of physical assault injuries that present to emergency departments for further evaluation and treatment.  But what happens after the assault compared to teens who are not assaulted?  Carter et al. (doi: 10.1542/peds.2014-3572) performed a prospective cohort study involving drug-using assaulted teens who presented to an urban Level 1 emergency department and compared them to a similar group of drug using teens who had not been assaulted and then followed both groups over the next two years  (collecting data on their well-being every 6 months).   
      Sadly there was a 40% increase in firearm violence in the assaulted group compared to the non-assaulted group—most having a firearm violent event within 6 months of the initial assault incident.  The authors take this finding further and identify risk factors that can further predict firearm violence in the assaulted group.
     What can we learn from this study?  We might want to do more than simply deal with the assault injuries themselves in the ED or in follow-up in a primary care setting—but instead try to intervene with more supportive services to these troubled youth in regard to helping  them with their substance abuse, mental health needs, need for revenge and /or desire to possess a firearm.  Obviously the goal is to do even more prevention work on firearm violence with teens even before this type of assault injury occurs—and Drs. Judith Schaechter and Eliot Nelson, experts on injury prevention from firearms share some important thoughts on this topic in an accompanying commentary (doi: 10.1542/peds.2015-0693). In this era of advocating for pediatrician inquiry into firearm access in homes with children and teens, this study and commentary are well worth your time and attention.

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