Youth violence secondary prevention initiatives in emergency departments: a systematic review.

OBJECTIVE: Youth violence continues to trouble Canadians. Emergency department (ED) visits by youth after a violent injury may represent a "teachable moment," and thus secondary violence prevention interventions may be effective. We conducted a systematic review to identify the success rates of any interventions, the populations likely to benefit and the outcome measures used. DATA SOURCE: We searched 8 databases (i.e., MEDLINE, EMBASE, PubMed, CINAHL, the Cochrane Database of Systematic Reviews, the ACP Journal Club, DARE and CENTRAL). STUDY SELECTION: Studies were included if they described and evaluated an intervention, were health care-based and targeted youth who were injured by violence. Two blinded investigators selected 15 articles from 181 abstracts. After full-text review, 8 articles were excluded, leaving 7 articles from 4 intervention programs. DATA EXTRACTION: All interventions used ED case management of the violently injured patient. One randomized control trial (RCT) demonstrated a significant reduction in reinjury rates (treatment group 8.1% v. control group 20.3%, p = 0.05). Another small RCT found no statistically significant reductions in repeat violence or service use. One retrospective cohort study demonstrated a lower relative risk (RR) in future criminal justice involvement (RR = 0.67, 95% confidence interval 0.45-0.99). A retrospective study of pediatric patients with violent injuries found only 1% of these youth returned with injuries as a result of repeat violence. DATA SYNTHESIS: Although all 4 case management interventions that we reviewed showed promise in the United States, small sample sizes and incomplete follow-up limited their ability to demonstrate significant decreases in reinjury.
CONCLUSION: Future research is necessary to help EDs capitalize on the opportunity to effectively reduce youth violence.