St. Louis hospital-based violence intervention program did not significantly affect reinjury outcomes

1. In this pilot cohort study, a multi-system hospital-based violence intervention program in the St. Louis region did not significantly affect reinjury outcomes.

2. Most participants were non-Hispanic Black, male, had Medicare or Medicaid insurance, and had a firearm injury.

Evidence Rating Level: 2 (Good)

Study Rundown: As the primary location for violence victims to receive care, hospitals are a key setting for interrupting the cycle of violence, thus alleviating further physical and psychological injury. While an increasing number of hospital-based violence intervention programs (HVIPs) have been set up across the United States, their effectiveness in reducing reinjury remains unclear. This study aimed to evaluate the implementation and reinjury outcomes among participants in a HVIP in the St. Louis area compared with non-enrolled controls. Results showed that a similar percentage of those in both groups experienced reinjury after 1 year. Among individuals in both groups who experienced reinjury, the majority suffered a firearm injury. Most HVIP participants were non-Hispanic Black, male, and had either Medicare or Medicaid insurance. Individual treatment plans (ITPs) were developed for nearly nine-tenths of participants, and almost half of participants received a service referral, most often for health and health care services or other basic needs such as food or state-issued identification. The generalizability of this study as limited by a small sample size and an inability to capture reinjuries outside the St. Louis area. Overall, this study demonstrated no clear evidence for a reduction in reinjury risk after implementation of a region-wide hospital-based violence intervention program.

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Relevant Reading: Violent injury prevention does not equal to violent crime prevention: an analysis of violence intervention program efficacy using propensity score methods

In-Depth [prospective cohort]: This study aimed to describe the characteristics and effectiveness of a multicenter HVIP based around the St. Louis area. Life Outside of Violence (LOV), was set up in 2018; participants were recruited from patients who presented with an acute non-fatal violent injury at a level 1 trauma center. Control participants also presented with an acute violent injury and were eligible for LOV but did not enroll. Patients were excluded if they had encounters for domestic violence assaults or sports injuries. Sociodemographic variables that were collected included patient age in years, sex, race and ethnicity, insurance, and neighborhood socioeconomic status. Reinjury was defined as receiving care at an LOV-associated center for a subsequent qualifying acute violent injury within 1 year after the index injury. A total of 198 patients were eligible for inclusion in the intervention. Complete covariate data was available for 3260 non-enrolled eligible patients. Of the 3260 non-enrolled eligible patients, 388 were matched to the interventional group as controls. The interventional group was more likely to have been injured by firearms (68% for enrollees vs. 41% for non-enrollees). Within 1 year of injury, violent reinjury occurred for 15 (8%) LOV participants and 29 (7%) control participants. Kaplan–Meier estimates for 1-year probability of reinjury were 7.6% (95% CI, 3.8% to 11.2%) among LOV participants and 7.4% (95% CI, 4.8% to 10.0%) in control participants. Among LOV participants who were reinjured, 9 of 15 (60%) were reinjured by firearms, compared with 16 of 29 (55%) reinjured control participants. The 198 LOV participants had a median age of 18 years (interquartile range [IQR], 15 to 21); 97% were non-Hispanic Black, 68% were male, 52% had Medicare or Medicaid insurance, and 68% had a firearm injury. Service referrals were received by 88 (44%) LOV participants, with the most common being for health and health care services (25%) and other basic needs (such as food and state-issued identification; 24%). Overall, these data suggested that a multicenter HVIP in the St. Louis area did not significantly affect reinjury outcomes.

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