Zun L, Downey L, Rosen J. The effectiveness of an ED-based violence prevention program. The American Journal of Emergency Medicine. 2006;(24):8-13.

INTRODUCTION

Youth violence is a significant problem in the urban trauma population. This is a study about an emergency department (ED)-based intervention designed to reduce the youth violence recurrence rate.

ABSTRACT

Patients aged 10 to 24 years who were victims of interpersonal violence (excluding child abuse, sexual assault, and intimate partner violence) were randomly enrolled in the study in a major urban level I trauma center. There were 188 participants. The control group was given a written list of services and the treatment group received an assessment and case management for 6 months. Both groups were evaluated 6 and 12 months after enrollment.

Indicators of the success of the intervention were reduction of self-reported revictimization or arrest and state-reported incarceration and reinjury. A significant difference between the treatment and control groups for self-reported reinjury was demonstrated (18 references).

REVIEW

The Study describes an ED-based intervention designed to target and lower youth injury recurrence rates. The research design utilizes an experimental model, which describes the effectiveness of a prevention program in the intervention group.

There are many strengths to the study. The methodology is rigorous, structured, and well thought out. The validity of the measurement tools is well documented.

There are several weaknesses, however, which limit a realistic application. High attrition rates, costs, lack of funding, turnover of case managers, and lack of transportation are logistical barriers that affect its application in the clinical practice setting. The study results demonstrated a reduction in self-reported reinjury rate in the intervention group. It is generally known, however, that self-report is a weak determinant due to inherent biases.

GENERAL COMMENTARY

The article is useful for trauma clinicians as it raises an awareness of youth violence. It is also helpful in terms of resources and referral systems for our young urban trauma population that a program like this may one day be available. In the interim, however, the study limitations and logistics preclude further program development and clinical utility.