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

CJEM. 2009 Mar;11(2):161-8. doi: 10.1017/s1481803500011131.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Canada / epidemiology
  • Emergency Service, Hospital / organization & administration*
  • Humans
  • Program Evaluation*
  • Secondary Prevention / methods*
  • Violence / prevention & control*