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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Article info
Publication history
Published online: August 08, 2022
Accepted:
August 6,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
