Violence: the relation between seriousness of injury and outcome in the criminal justice system

Intentional injury and violent death after intimate partner violence. A retrospective matched-cohort study

The incidence of intimate partner violence (IPV) varies according to IPV definitions and data collection approaches. The criminal Justice system assesses IPV through a review of the evidence gathered by the police and the court hearings. We aimed to determine the association between IPV, as identified in criminal Justice disposition records, and subsequent healthcare-identified intentional injury inflicted by others, including violent death. We conducted a retrospective population-based matched-cohort study using linked multisectoral databases. Female adult Manitoba residents identified as victims of IPV in provincial prosecution and disposition records 2004 to 2016 (n = 20,469) were matched to three non-victims (n = 61,407) of similar age, relationship status and place of residence at the date of the IPV incident. Outcomes were first healthcare use for intentional injury and violent death, assessed in Emergency Department visits, hospitalizations and Vital Statistics deaths records. Conditional Cox Regression was used to obtain Hazard Ratios (HR) with 95% confidence intervals (CI). The risk of intentional injury was 8.5 per 1000 women among non-victims of IPV and 55.8 per 1000 women among IPV victims. The Hazard Ratios associated with IPV were 3.8 (95% CI: 3.4, 4.3) for intentional injury and 4.6 (95% CI: 2.3, 9.2) for violent death, after adjustment. IPV victims experienced half the risk of subsequent intentional injury if the accused received a probation sentence. Our findings suggest that Justice involvement represents an opportunity for intersectoral collaborative prevention of subsequent intentional injury among IPV victims.

Arrests Among High-Risk Youth Following Emergency Department Treatment for an Assault Injury

INTRODUCTION

Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk, assault-injured, drug-using youth following emergency department treatment.

METHODS

Youth (aged 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression.

RESULTS

In the longitudinal cohort, 511 youth seeking emergency department care (assault injury group n=299, comparison group n=212) were aged ≥18 years and were included for analysis. Youth in the assault injury group cohort had a 47% higher risk of arrest than the comparison group (38.1% vs 25.9%, RR=1.47, p<0.05). In unadjusted analyses, male sex, assault injury, binge drinking, drug use disorder, and community violence exposure were all associated with increased risk of arrest during the follow-up period. Cox regression identified that male sex (hazard ratio=2.57), drug use disorder diagnosis (hazard ratio=1.42), assault injury at baseline (hazard ratio=1.63), and community violence exposure (hazard ratio=1.35) increased risk for arrest.

CONCLUSIONS

Drug-using assault-injured youth have high rates of arrest. Emergency department and community interventions addressing substance use and violence involvement may aid in decreasing negative violence and criminal justice outcomes among high-risk youth.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01152970.

The validity of injury surveillance system measures of assault: a lesson from the study of violence in Alaska

This article considers the validity of estimates of intentional violence using a statewide injury recording system: the Alaska Trauma Registry (ATR). One benefit of using data from an injury surveillance system is that its records are generated without police involvement, thereby reducing the likelihood of undercounting. However, there is reason to suspect that measures of violence derived from injury surveillance systems do not accurately measure underlying levels of assault in a population and are instead partly a reflection of influential patient characteristics. The ATR was used to compare assault injury cases of Alaska Natives with those of non-Natives to determine if patient characteristics varied between racial groups and to determine if those characteristics served to bias comparisons of injury rates. Results indicate that differences in assault injury rates are partly attributable to a greater proportion of Alaska Native patients being hospitalized for injuries of only minor or moderate severity.

Preventing violence — caring for victims

Part of the great tradition of surgery, exemplified by the Royal College precept, 'From Here Health', is that surgeons are committed to prevention as well as cure. King James IV and his able contemporary in China, where this lecture was delivered, Emperor Hongzhi, would have approved of it. This tradition has, perhaps, been neglected since the emergence of public health as a medical specialty. However, opportunities and reasons for surgeons to contribute to prevention have never been greater. Community violence prevention--increasing public safety in the towns and cities in which surgeons work--is an example. Primary prevention of injury achieved by collecting and sharing unique information about weapons and the locations of assault, secondary prevention achieved by combining wound care with motivational interviewing to reduce alcohol misuse, and tertiary prevention achieved by early referral to mental health professionals for treatment of post-traumatic stress, have been integrated into a new care pathway which combines prevention with surgical care. Individuals and communities would benefit substantially if every surgical specialty incorporated prevention--a professionally highly-rewarding activity--into its training curriculum.

Preventing alcohol-related violence: a public health approach

BACKGROUND

Studies of the relationship between alcohol and violent injury confirm that while there is some evidence of a direct pharmacological association, many other factors are relevant to the frequency and severity of both violent perpetration and being a victim of violence. It is now widely recognized that official police statistics are a poor indicator of the nature and extent of public violence.

AIMS

Accident and emergency departments and trauma surgeons are not only in a position to provide more accurate information on the nature and extent of clinically significant injury, but they can contribute substantially to violence prevention. This can be achieved through individually targeted interventions in conjunction with other clinicians on the one hand, and on the other through public health and community initiatives, in conjunction with other community agencies, including the police and local authorities. This article describes some of those initiatives and the evidence underpinning them.

Recording of community violence by medical and police services

OBJECTIVES

To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police.

METHODS

Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located.

RESULTS

Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0).

CONCLUSIONS

Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0-10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection.

Emergency medicine and police collaboration to prevent community violence

An important responsibility of emergency departments is the management of injuries sustained in assaults. Most assaults, including many causing serious injury, are not reported and not recorded by the police. This is important because police investigation and the conviction of offenders has a substantial deterrent effect and because information about the circumstances of intentional injury is key to prevention. Recent investigation of ED-police collaboration has shown that many of the injured, and ED staff want offenses to be reported but that there are attitudinal, logistic, and ethical-legal obstacles to achieving this. Organized joint efforts by emergency medicine personnel and police departments, on the basis of a sound legal and ethical framework to protect the rights of both victims and offenders, should deter more violent offenders and would-be violent offenders. They also provide the police with unique aggregate, nonconfidential information that is of substantial help in tackling violence. ED data can be used to measure and refine violence prevention initiatives and are being developed as the basis of a new, independent measure of police performance. Strategies, practical ideas to overcome obstacles, and directions for future research are suggested.

Trends in community violence in England and Wales 1995-1998: an accident and emergency department perspective

OBJECTIVES

To identify overall, seasonal, sex and age specific national trends in community violence from an accident and emergency (A&E) department perspective.

DESIGN AND SETTING

Prospective collection of national violence data from a stratified random sample of 33 A&E departments in England and Wales.

METHODS

Data were analysed for the three years from May 1995 to April 1998. Time series statistical methods were used to detect trends among those aged 0-10, 11-17, 18-30, 31-50 and 51 + years.

RESULTS

121475 assaults were identified: 89533 (74%) men sustained injury. Forty five per cent were aged 18-30. The significant trends were an increase in injured women and those aged 31-50. Significant seasonal trends were identified for both sexes and all age groups: peaks were found in July to September and troughs in February to April.

CONCLUSIONS

There was no overall significant change in levels of violence between 1995-1998 from an A&E department perspective. Numbers of women injured and those aged 31-50 increased significantly. The incidence of injury sustained in community violence is biphasic: is highest during July to September and lowest during February to April. National A&E department violence surveillance provides a unique perspective.