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Development of a clinical prediction instrument to estimate risk of initial violent injury

  • Benjamin H. Li
    Correspondence
    Corresponding author.
    Affiliations
    Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America

    Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America

    Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America

    At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
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  • Jason S. Haukoos
    Affiliations
    Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America

    Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America

    Department of Epidemiology, Colorado School of Public Health, 13001 East 17th Place, 3rd Floor, Mail Stop B119, Aurora, CO, 80045, United States of America
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  • Matthew M. Gangidine
    Affiliations
    Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America

    Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America
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  • Emily Hopkins
    Affiliations
    Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO, 80204, United States of America

    Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America
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  • Michelle McDaniel
    Affiliations
    Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America

    At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
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  • Johnnie E. Williams Jr.
    Affiliations
    Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America

    At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
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  • Jerry L. Morgan Jr.
    Affiliations
    Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America

    At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
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  • Erica Green
    Affiliations
    Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America

    At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
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  • Alma R. Mireles
    Affiliations
    Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America

    At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
    Search for articles by this author
  • Jose Palacios
    Affiliations
    Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America

    At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
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  • Jesus H. Ramirez
    Affiliations
    Office of Education, Denver Health Medical Center, 601 Broadway, 9th Floor, Denver, CO, 80203, United States of America

    At-risk Intervention and Mentoring (AIM), Gang Rescue And Support Project (GRASP), Denver Youth Program, 1625 East 35th Avenue, Denver, CO, 80205, United States of America
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  • Katherine M. Bakes
    Affiliations
    Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO, 80045, United States of America

    Department of Emergency Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, United States Department of Veterans Affairs, 1700 North Wheeling Street, Aurora, CO, 80045, United States of America
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      Highlights

      • Interpersonal violent injuries are a public health emergency, with high rates of morbidity, mortality, and recidivism, and previously described risk characteristics have primarily focused on re-injury, violence perpetration, and firearms.
      • We described associations between sociobehavioral predictors and first-time violent injury victimization of all injury types, and developed an internally valid predictive risk score that grouped individuals by increasing prevalence of violent injury.
      • Our risk score has the potential to be utilized as a primary prevention strategy across multiple clinical settings, in order to prevent initial violent injury victimization.

      Abstract

      Background

      Interpersonal violent injury is a public health crisis, disproportionately affecting young people of color. We aimed to evaluate associations between sociobehavioral predictors and first-time violent injury, and to develop a predictive risk score for violent injury.

      Methods

      We performed a retrospective case-cohort study of adolescents aged 12–18 years. Multivariable logistic regression was used to estimate associations between 35 candidate variables and interpersonal first-time violent injury resulting in an emergency department (ED) visit. Multiple imputation was used to account for missing values and a risk score was developed by multiplying regression coefficients by 10 to generate a composite tool to predict initial violent injury (IVI). Discrimination and calibration were assessed using 10-fold cross validation.

      Results

      19,210 adolescents were included, 276 (1.4%) as victims of IVI. The final model, the Initial Violent Injury Risk Prediction Tool (IVI-RPT), included: age, fight within the prior year, trouble with the law, and alcohol use. IVI-RPT scores were categorized as: 0–7 (low risk), 8–16 (moderate), and 17–26 (high), and IVI prevalence was 0.8% (95% confidence interval [CI]: 0.6%, 0.9%), 2.5% (95% CI: 1.9%, 3.1%), and 5.3% (95% CI: 4.1%, 6.6%), respectively. The area under the receiver operating characteristic curve was 0.70 (95% CI: 0.66, 0.73), while the slope of the calibration curve was 1.1 (95% CI: 0.9, 1.2).

      Conclusions

      We developed a promising clinical prediction instrument, the IVI-RPT, that categorizes individuals into risk groups with increasing probabilities of violent injury. External validation of this tool is required prior to clinical practice implementation.

      Keywords

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