Preventing violence — caring for victims

Linking emergency care and police department data to strengthen timely information on violence-related paediatric injuries

BACKGROUND

Combined ED and police department (PD) data have improved violence surveillance in the UK, enabling significantly improved prevention. We sought to determine if the addition of emergency medical service (EMS) data to ED data would contribute meaningful information on violence-related paediatric injuries beyond PD record data in a US city.

METHODS

Cross-sectional data on self-reported violence-related injuries of youth treated in the ED between January 2015 and September 2016 were combined with incidents classified by EMS as intentional interpersonal violence and incidents in which the PD responded to a youth injury from a simple or aggravated assault, robbery or sexual offence. Nearest neighbour hierarchical spatial clustering detected areas in which 10 or more incidents occurred during this period (hotspots), with the radii of the area being 1000, 1500, 2000 and 3000 ft. Overlap of PD incidents within ED&EMS hotspots (and vice versa) was calculated and Spearman's r tested statistical associations between the data sets, or ED&EMS contribution to PD violence information.

RESULTS

There were 935 unique ED&EMS records (ED=381; EMS=554). Of these, 877 (94%) were not in PD records. In large hotspots >2000 ft, ED&EMS records identified one additional incident for every three in the PD database. ED and EMS provided significant numbers of incidents not reported to PD. Significant correlations of ED&EMS incidents in PD hotspots imply that the ED&EMS incidents are as pervasive across the city as that reported by PD. In addition, ED and EMS provided unique violence information, as ED&EMS hotspots never included a majority (>50%) of PD records. Most (676/877; 77%) incidents unique to ED&EMS records were within 1000 ft of a school or park.

CONCLUSIONS

Many violence locations in ED and EMS data were not present in PD records. A combined PD, ED and EMS database resulted in new knowledge of the geospatial distribution of violence-related paediatric injuries and can be used for data-informed and targeted prevention of violence in which children are injured-especially in and around schools and parks.

Crime and violence in Brazil: Systematic review of time trends, prevalence rates and risk factors

Between 1980 and 2010 there were 1 million homicides in Brazil. Dramatic increases in homicide rates followed rises in inequality, more young men in the population, greater availability of firearms, and increased drug use. Nevertheless, disarmament legislation may have helped reduce homicide rates in recent years. Despite its very high rate of lethal violence, Brazil appears to have similar levels of general criminal victimization as several other Latin American and North American countries. Brazil has lower rates of drug use compared to other countries such as the United States, but the prevalence of youth drug use in Brazil has increased substantially in recent years. Since 1990, the growth of the Brazilian prison population has been enormous, resulting in the fourth largest prison population in the world. Through a systematic review of the literature, we identified 10 studies assessing the prevalence of self-reported offending in Brazil and 9 studies examining risk factors. Levels of self-reported offending seem quite high among school students in Brazil. Individual and family-level risk factors identified in Brazil are very similar to those found in high-income countries.

Trends in admission to hospital for assault in Northern Ireland, 1996/97-2008/09

BACKGROUND

The aim of the study is to investigate in-patient admission trends for assaults in Northern Ireland. Of particular interest was whether trends in the hospital data increased in line with police statistics, or decreased in line with the Northern Ireland Crime Survey, and paramilitary style punishment attacks.

METHODS

Time-series analysis of Northern Ireland hospital inpatient data, 1 April 1996 until 31 March 2009, obtained from the Northern Ireland Department of Health, Social Services and Public Safety was performed. For comparative purposes, police data for 'wounding/grievous bodily harm with intent' and punishment attacks were obtained from the Police Service of Northern Ireland. Data were standardized using rate per 100 000 people.

RESULTS

The hospital in-patient data set comprised a total of 25 412 cases, over the period of 1 April 1996-31 March 2009. Inpatient admissions for assault-related injuries peaked in 2001/02 (n = 2297). The majority of assaults treated over the entire period was from bodily force (62%, n = 15 874). A 23% decline was observed for hospital admission rates for assault-related injuries. This decreasing trend was found for all types of assaults. The greatest decline was for assault by firearm discharge (55%).

CONCLUSION

The decline in assault-related hospital admissions is in contrast to the increase reported police data, supporting findings from previous studies. Similar decreasing trends in the hospital and punishment attack data are also identifiable, particularly for Belfast.

Interpersonal violence and facial fractures

PURPOSE

Interpersonal violence is a major health hazard that contributes to the high volume of trauma seen in the emergency department. It is also one of the principal causes of maxillofacial fractures.

MATERIALS AND METHODS

The present study was a retrospective analysis of patients referred to, and treated at, the Oral and Maxillofacial Surgery Unit at Christchurch Hospital during an 11-year period (1996 to 2006). The variables examined included patient demographics, fracture types, mode of injury, and treatment delivered.

RESULTS

An increase was found in the number of fractures due to interpersonal violence in the second half of the study, although the proportion remained the same. The age of the patients ranged from 9 to 89 years (mean 28). The male-to-female ratio was 9:1. Of the patients, 87% had alcohol involvement. The mandible was the most common site of fracture, followed by the zygoma. Other midface fractures, including Le Fort fractures, were less frequently observed. Of the patients, 59% were hospitalized and 56% required surgery, with internal fixation necessary in 41% of patients.

CONCLUSION

An increase occurred in the number of facial fractures associated with interpersonal violence during the study period. Young male adults were the most affected demographic group, with alcohol a main contributing factor. Violence-related facial fracture is a health hazard that deserves more public awareness and implementation of preventive programs.