An Unexamined Cause of Emergency Department Visits for Urban Youth

Introduction: Assault-related injuries result in substantial morbidity, mortality, medical costs and work loss costs for urban youth and are often treated in an emergency department (ED) setting. Previous work shows that peer fights are the primary etiology of assault-injuries for urban youth. This study extends these findings and evaluates to what extent these incidents are related to patterns of aggressive behavior or bullying. Additionally, we explore differences in proximal risk factors such as attributions about the incident, attitudes about violence, and previous involvement in violence in order to inform ED intervention strategies for youth involved in bullying.

Methods: Using medical record data that included chief complaint, diagnosis and triage notes, we identified and enrolled 187 assault-injured youth (ages 10-15; 61% male) from EDs in Baltimore and Philadelphia between June 2014 and June 2016. Patients and one caregiver completed a questionnaire that described the altercation that resulted in a physical injury and ED visit, and also completed scales that assessed their attitudes about violence and previous involvement in violence. Descriptive analyses included tests of group differences (i.e., t-tests and chi-square analyses). Regression analyses included type of assault as a predictor variable.

Results: When describing the altercation that lead to an ED visit for treatment of a physical injury, 40.6% of youth reported they were victims of bullying and more than 60% said that the perpetrators had hurt or threatened to hurt them in the past. The majority (63.2%) of bullying incidents happened at school. Youth who said they were bullied were significantly more likely to have been involved in a group fight and to have identified the person injuring them as a classmate. There were no differences between bullied and non-bullied youth with respect to weapon involvement, police investigation, or type of transport to the hospital. Youth with injuries attributed to a bullying episode were more likely to report that their ED visit was stressful (β= 1.078, p<.02) and were less likely to display aggressive attitudes (β= -2.603, p<.001). They were also more likely to report past month bullying victimization (β= 6.150, p<.001), but trend towards less overall involvement in violence (β= -3.172, p<.10).

Conclusion: A substantial number of assault-injuries treated in the ED are due to bullying and stem from incidents that occur at school. Our findings suggest the need for ED interventions sensitive to two different injury etiologies and the potential importance of connections with school-based prevention.