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Abstract
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BACKGROUND: While hospital-based violence intervention programs (HVIPs) are primarily designed to aid youth victims of gun violence at high risk for re-injury, the root causes and complex outcomes of community violence are varied. In this study, we examined the risk factors for violent penetrating injury and how the risk of adverse outcomes for survivors differs by injury type (stabbing versus gunshot wound).
METHODS: This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center (BMC) emergency department (ED) for a penetrating injury due to community violence between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury within three years after surviving a penetrating injury.
RESULTS: Of the 4280 survivors of the initial violent penetrating injury, there were 88 deaths (2.1%) and 568 violent re-injuries (13.3%) within three years. Compared to gunshot wound victims, stab wound victims were 31% less likely to be re-injured with a gunshot wound (HR = 0.69, 95%CI = 0.51-0.93), 72% more likely to be re-injured with a stab wound (HR = 1.72, 95%CI = 1.21-2.43), and 49% more likely to be re-injured by assault (HR = 1.49, 95%CI = 1.14-1.94). While survivors of stabbing and firearm injuries were equally at risk for three-year all-cause mortality, stab wound victims were 3.75 times more likely to die by a drug/alcohol overdose (HR = 3.75, 95%CI = 1.11-20.65).
CONCLUSIONS: Patients surviving a stab wound have a significantly higher risk of violent re-injury by stabbing or assault, and risk of death by drug/alcohol overdose. HVIPs with similar patient populations should explore options to expand partnerships with drug treatment programs. These results illustrate two distinct populations of victims of violence─gunshot victims and stabbing/assault victims─with separate risk factors and outcomes, mediated by substance use disorder. LEVEL OF EVIDENCE: Epidemiological study, level III.
Language: en |