Brief emergency department screening tool may help identify high-risk youths for future firearm violence

1. Researchers developed a 1-2 minute screening tool that uses a 10-point SaFETy score relating to risk factors that correspond with an increased risk of future firearm violence.

2. This tool shows potential for being incorporated as part of routine care at the emergency department (ED) to help identify high-risk youths, which could in turn be used to help identify areas of focus for violence prevention or intervention.

Evidence Rating Level: 2 (Good)

Study Rundown: Firearms are the cause of death in over 86% of homicides among youths 15-24 years of age in the United States, making firearm violence an important public health issue. In the ED, there is currently no brief screening tool of clinical relevance that could help to detect where violence prevention efforts should be placed. In this 24-month prospective cohort study in Flint, Michigan, researchers developed a screening tool to help detect youths at high-risk of future firearm violence. The factors that were most predictive of future firearm violence were categorized as violence victimization, fighting, peer influences, and community exposure. Items from these areas were chosen to create the 10-point SaFETy score (Serious Fighting, Friend Weapon Carrying, Community Environment, and Firearm Threats) to evaluate risks. In the validation set, a higher SaFETy score was related to a higher risk for future firearm violence. The screening tool can be administered in 1-2 minutes, which suggests potential for incorporation as part of routine care at the ED to help identify high-risk youths, which could in turn be used to help identify areas of focus for violence prevention or intervention.

Strengths of the study include the two-year study length and the development of a previously non-existent brief clinical screening tool that could help identify youth being treated at the ED who are at risk of future firearm violence. Limitations of this study include a sample limited to a single urban emergency department and the lack of non-substance-using participants. In addition, the use of self-reported data could have led to reduced response accuracy if the answer may be viewed negatively.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: Firearm violence among high-risk emergency department youth after an assault injury

In-Depth [prospective cohort]: In this study, youths 14-24 years of age who sought ED care at a Flint, Michigan level 1 trauma center were enrolled from September 2009 through December 2011. Of the 599 enrolled youths, 349 had injury related to assault, and 250 had non-assault related injuries. A screening survey was administered to the youths, with follow-up self-assessments administered at 6, 12, 18, and 24 months. Participants received monetary compensation for completing the assessments. Regarding the follow-up period, 80.6% (n = 483) of participants could be categorized as having involvement with firearm violence (52.2%) or not (47.8%). In the validation set, a SaFETy score increase of 1 point was related to a higher risk for future firearm violence (odds ratio [OR], 1.47; 95%CI, 1.23 to 1.79). Five risk strata were identified in the training data: SaFETy scores of 0, 1-2, 3-5, 6-8, and 9-10 corresponded to rates of future firearm violence of 18.2%, 40.0%, 55.8%, 81.3%, and 100%, respectively.

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