Violence Perpetration Among Patients Hospitalized for Unintentional and Assault-Related Firearm Injury

Ali Rowhani‐Rahbar · Mary D. Fan · Joseph A. Simonetti · Vivian H. Lyons · Douglas Zatzick · Frederick P. Rivara

22 citations0/0 files storedAnnals of Internal Medicine

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Gun Ownership and Violence Research Crime Patterns and Interventions Homicide, Infanticide, and Child Abuse

Abstract

BACKGROUND: Hospital-based violence intervention programs typically focus on patients whose firearm injury occurred through interpersonal violence (assault). Knowledge of violence perpetration by victims of unintentional (accidental) firearm injury is limited. OBJECTIVE: To examine violence perpetration before and after a patient becomes hospitalized for firearm injury according to injury intent (intentional [assault] or unintentional [accidental]). DESIGN: A case-control study and a retrospective cohort study. SETTING: Hospitals in Washington. PATIENTS: Persons aged 15 years or older hospitalized for a firearm injury, other injuries, or a noninjury reason from 2006 to 2007. MEASUREMENTS: In the case-control study, the odds of violence-related arrest from 2001 through hospitalization by injury intent among 3 groups were compared. In the cohort study, the rates of violence-related arrest from hospitalization through 2011 by injury intent among 3 groups were compared. RESULTS: Patients with unintentional firearm injuries (n = 180) were more likely than those with other unintentional injuries (n = 62 795; odds ratio [OR], 2.01 [95% CI, 1.31 to 3.09]) and no injuries (n = 172 830; OR, 3.43 [CI, 2.22 to 5.32]) to have been arrested for a violent crime before hospitalization. Prior violence-related arrest did not differ between patients with assault-related firearm injuries (n = 339) and those with other assault-related injuries (n = 2342; OR, 1.10 [CI, 0.84 to 1.46]). During follow-up, the cumulative incidence of violence-related arrest for patients with unintentional and assault-related firearm injuries was 10% and 15% (subhazard ratio, 1.88 [CI, 1.11 to 3.17] and 1.61 [CI, 1.08 to 2.44]), respectively, compared with 1% for those without injuries. LIMITATION: Exclusion of self-inflicted injuries, misclassification of intent, and ascertainment bias. CONCLUSION: Some firearm injuries classified as accidental may indicate involvement in the cycle of violence and present an opportunity for intervention. PRIMARY FUNDING SOURCE: City of Seattle and the University of Washington Royalty Research Fund.

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2011On the overlap between victimization and offending: A review of the literature 1998Guns, Youth Violence, and Social Identity in Inner Cities 2010A Longitudinal Assessment of the Victim-Offender Overlap 2000Race, Socioeconomic Status, and Cause-Specific Mortality 2014Violent Reinjury and Mortality Among Youth Seeking Emergency Department Care for Assault-Related Injury 2015Firearm Violence Among High-Risk Emergency Department Youth After an Assault Injury 2006Exploring Demographic, Structural, and Behavioral Overlap Among Homicide Offenders and Victims 2009Before and After the Trauma Bay: The Prevention of Violent Injury Among Youth

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