The epidemiology of assault across the West Midlands

Significantly reduced rates of interpersonal violence in an urban Danish population 2003-2021

This study aimed to describe changes in annual incidence rates and the severity of deliberate interpersonal violence based on hospital and forensic data in a Danish urban population 2003-2021. Included in the study were local victims of violence admitted to Odense University Hospital and/or subjected to medico-legal autopsy at the Institute of Forensic Medicine, University of Southern Denmark from 2003 to 2021. Based on population counts, we estimated overall and gender specific annual incidence rates in different age groups. For the 14,788 victims included in the study, the gender-specific incidence rates were 5.7 for males and 2.4 for females per 1000 population/year. The incidence rates decreased almost fourfold for both genders in all age groups. In both gender, the incidence rate of violence involving mild injuries decreased significantly, whereas incidence rate of violence involving severe injuries remained unchanged over the study period. The proportion of superficial lesions decreased and the proportion of wounds, bone fractures, and deep lesions increased. The proportion of victims with injuries from knifes increased from 3.0 to 5.4% in the study period. Overall, 0.3% died from their injuries. The present study showed a significant decreased in the incidence rate of violence based on hospital and forensic data. The decrease involved solely victims with less severe injuries. We recommend studies combining hospital, forensic, and police data.

Blows or Falls? Distinction by Random Forest Classification

In this study, we propose a classification method between falls and blows using random forests. In total, 400 anonymized patients presenting with fractures from falls or blows aged between 20 and 49 years old were used. There were 549 types of fractures for 57 bones and 12 anatomical regions observed. We first tested various models according to the sensibility of random forest parameters and their effects on model accuracies. The best model was based on the binary coding of 12 anatomical regions or 28 bones with or without baseline (age and sex). Our method achieved the highest accuracy rate of 83% in the distinction between falls and blows. Our findings pave the way for applications to help forensic experts and archaeologists.

How often do nurses suspect violence and domestic violence in local emergency medical communication centre? A cross-sectional study

OBJECTIVE

To assess the extent of violence that is revealed by screening at first contact with a local out-of-hours emergency medical communication centre (LEMC; Norwegian 'Legevaktsentral').

DESIGN

Cross-sectional study.

SETTING

Arendal LEMC, covering 10 municipalities in south-eastern Norway. All contacting patients (telephone or personal attendance) were asked by nurse whether the encounter was related to violence.

SUBJECTS

All first patient encounters at Arendal LEMC.

MAIN OUTCOME MEASURES

Number and proportion of cases where the nurses suspected violence, both domestic violence and other violence. Incidence rate of violence, age and gender distribution of patients, time of day and reason for encounter.

RESULTS

Violence was suspected in 336 of 103,467 first patient encounters (0.3%), of which 132 (0.1%) was domestic violence. Patients were female in 50.6% of all violence cases, and in 79% of domestic violence cases. Incidence rates were 137 per 100,000 person-years for all violence, and 53 for domestic violence.

CONCLUSIONS

This study indicates violence may be revealed in three of 1000 first encounters to an LEMC when nurses screen systematically for domestic or other violence.Key points    Violence as underlying reason for encounter with primary care emergency health services is probably often not discovered by health personnel.   • We examined how often nurses reveal violence upon first contact when systematically asking all patients.  • Violence was suspected in 0.3% of cases, and domestic violence in 0.1%.  • Among patients with disclosed domestic violence, 79% were female.

Neighborhood Socioeconomic Deprivation and Youth Assault Injuries in Vancouver, Canada

OBJECTIVE

To examine the degree to which neighborhood socioeconomic deprivation influences the risk of youth assault injury.

STUDY DESIGN

Population-based retrospective study of youth aged 10-24 years seeking emergency medical care between 2012 and 2019 at 14 hospitals in Vancouver, Canada. Neighborhood material and social deprivation were examined as independent predictors of assault injury, accounting for spatial autocorrelation and controlling for neighborhood drinking establishment density.

RESULTS

Our data included 4166 assault injuries among 3817 youth. Male sex, substance use, and mental health disorders were common among victims of assault. Relative to the least deprived quintile of neighborhoods, assault injury risk was 2-fold higher in the most materially deprived quintile of neighborhoods (incidence rate ratio per quintile increase, 1.17; 95% CI 1.06-1.30; P < .05), and risk in the most socially deprived quintile was more than 3-fold greater than in the least deprived quintile (incidence rate ratio per quintile increase, 1.35; 95% CI 1.21-1.50; P < .001). Assault risk was 147-fold greater between 2 and 3 AM on Saturday relative to the safest hours of the week.

CONCLUSIONS

Neighborhood socioeconomic deprivation substantially increases the risk of youth assault injury. Youth violence prevention efforts should target socioeconomically deprived neighborhoods.

Risk Factors for Violent Injuries and Their Severity Among Men in The Gambia

A matched case-control study was conducted to identify risk factors for injury from physical violence and its severity in Gambian men. Study participants were recruited from eight emergency rooms and outpatient departments in two health administrative regions. Cases were male patients aged ⩾15 years who had been violently injured. A control patient for each case, matched for the hospital or health center, date of injury, gender, and age, was selected from those injured due to nonviolence causes. In total, 447 case-control pairs were recruited. Results of the conditional logistic regression analysis showed that case patients who worked as businessmen (odds ratio [OR], 1.93; 95% confidence interval [CI] [1.16, 3.20]), had monthly household income of ⩾US$311 (OR, 2.12; 95% CI [1.06, 4.24]), had two or more male siblings (OR, 2.20; 95% CI [1.15, 4.21]), had consumed alcohol in the past week (OR, 3.32; 95% CI [1.25, 8.84]), and had been physically abused (OR, 5.10; 95% CI [2.71, 9.62]) or verbally abused (OR, 1.63; 95% CI [1.04, 2.56]) in the past 12 months were significantly associated with the occurrence of injury from physical violence. Severe injuries during the violence were significantly associated with events that took place in public spaces, with certain injury mechanisms (being stabbed/cut/pierced, struck by an object, assaulted by fist punching/leg kicking/head-butting, and scalded/stoned), having injuries to the upper extremities, and smoked cigarettes in the past week. Specific public health programs aimed at preventing physical violence and severe injuries against men should be developed in The Gambia based on modifications of the identified risk factors.

Are injury admissions on weekends and weeknights different from weekday admissions?

PURPOSE

To examine whether hours of a day and days of a week influence injury pattern, means of evacuation, and hospital resource utilization.

METHODS

A study based on the Israeli National Trauma Registry of patients hospitalized due to injury between 2008 and 2015.

RESULTS

Of 293,077 subjects included; 32.8% were admitted on weekends (weekend-days 16.7% and weekend-nights 16.1%), 20.0% on weeknights and 47.2% on weekdays. Compared with weekday admissions, weekend and weeknight admissions had higher risk of hospitalization from violence and fall-related injuries, but lower risk from road traffic injuries (RTI) except for weekend-day admissions adjusted for age, gender, and ethnicity. Hospitalization due to burn injuries was greater on weekends, particularly on weekend-days. Hospitalization for violence and burn injuries was greater on weekend-nights vs weeknights, while injuries from other unintentional causes were greater on weeknights than weekend-nights. Furthermore, patients admitted on weekends and weeknights were more likely to have severe and critical injuries, greater utilization of intensive care unit and to be referred for rehabilitation, but were less likely to receive prehospital emergency medical service. In stratified analyses, RTI-related hospitalization was greater on weekends among youth and adults aged 15-64 years, males and Arabs, while burn injuries were more likely among weekend admissions for children aged 0-14 years, female and Jews.

CONCLUSIONS

Injury pattern and resource utilization are related to time. Therefore, injury prevention and intervention efforts should account for hours of a day and days of a week, particularly in relation with age, gender, and ethnicity.

Demographic and socioeconomic inequalities in the risk of emergency hospital admission for violence: cross-sectional analysis of a national database in Wales

OBJECTIVES

To investigate the risk of emergency hospital admissions for violence (EHAV) associated with demographic and socioeconomic factors in Wales between 2007/2008 and 2013/2014, and to describe the site of injury causing admission.

DESIGN

Database analysis of 7 years' hospital admissions using the Patient Episode Database for Wales (PEDW).

SETTING AND PARTICIPANTS

Wales, UK, successive annual populations ∼2.8 million aged 0-74 years.

PRIMARY OUTCOME

The first emergency admission for violence in each year of the study, defined by the International Classification of Diseases V.10 (ICD-10) codes for assaults (X85-X99, Y00-Y09) in any coding position.

RESULTS

A total of 11 033 admissions for assault. The majority of admissions resulted from head injuries. The overall crude admission rate declined over the study period, from 69.9 per 100 000 to 43.2 per 100 000, with the largest decrease in the most deprived quintile of deprivation. A generalised linear count model with a negative binomial log link, adjusted for year, age group, gender, deprivation quintile and settlement type, showed the relative risk was highest in age group 18-19 years (RR=6.75, 95% CI 5.88 to 7.75) compared with the reference category aged 10-14 years. The risk decreased with age after 25 years. Risk of admission was substantially higher in males (RR=4.55, 95% CI 4.31 to 4.81), for residents of the most deprived areas of Wales (RR=3.60, 95% CI 3.32 to 3.90) compared with the least deprived, and higher in cities (RR=1.37, 95% CI 1.27 to 1.49) and towns (RR=1.32, 95% CI 1.21 to 1.45) compared with villages.

CONCLUSIONS

Despite identifying a narrowing in the gap between prevalence of violence in richer and poorer communities, violence remains strongly associated with young men living in areas of socioeconomic deprivation. There is potential for a greater reduction, given that violence is mostly preventable. Recommendations for reducing inequalities in the risk of admission for violence are discussed.

The effect of deprivation on the incidence of mandibular fractures in a British city

AIM

To examine the relationship between social and material deprivation and mandibular fractures.

METHOD

Three hundred and forty three consecutive patients who underwent mandibular fracture fixation were selected for the study. After exclusions, 290 were divided into age groups and ranked according to their Index of Multiple Deprivation (IMD) score. Rankings were determined using postcodes, and divided into quintiles for statistical analysis.

RESULTS

Ages ranged from 7 to 82 with 146 (50%) patients aged between 20 and 29. Males accounted for 85% of cases. The most common site of fracture was the angle (n = 195) and assault was shown to be the most common mechanism of injury (63.3%). A strong relationship was demonstrated between fractures of the mandible and worsening deprivation, with the most striking relationship seen with fractures sustained as a consequence of assault. Females were less likely than males to sustain a fracture of the mandible as a consequence of assault; however, when assault was the mechanism of injury they were also likely to be from a deprived background.

CONCLUSION

This study has demonstrated that a strong relationship exists between deprivation and the incidence of mandibular fractures in our catchment area. Fractures that resulted from interpersonal violence were shown to have a particularly strong correlation with deprivation.

Epidemiology and resource utilization in pediatric facial fractures

BACKGROUND

Pediatric facial fractures, although uncommon, have a significant impact on public health and the US economy by the coexistence of other injuries and developmental deformities. Violence is one of the most frequent mechanisms leading to facial fracture. Teaching hospitals, while educating future medical professionals, have been linked to greater resource utilization in differing scenarios. This study was designed to compare the differences in patient characteristics and outcomes between teaching and non-teaching hospitals for violence-related pediatric facial fractures.

METHODS

Using the 2000-2009 Kids' Inpatient Database, 3881 patients younger than 18 years were identified with facial fracture and external cause of injury code for assault, fight, or abuse. Patients admitted at teaching hospitals were compared to those admitted at non-teaching hospitals in terms of demographics, injuries, and outcomes.

RESULTS

Overall, 76.2% of patients had been treated at teaching hospitals. Compared to those treated at non-teaching hospitals, these patients were more likely to be younger, non-white, covered by Medicaid, from lower income zip codes, and have thoracic injuries; but mortality rate was not significantly different. After adjusting for potential confounders, teaching status of the hospital was not found as a predictor of either longer lengths of stay (LOS) or charges.

CONCLUSIONS

There is an insignificant difference between LOS and charges at teaching and non-teaching hospitals after controlling for patient demographics. This suggests that the longer LOS observed at teaching hospitals is related to these institutions being more often involved in the care of underserved populations and patients with more severe injuries.

What is expected from a facial trauma caused by violence?

OBJECTIVES

The aim of this retrospective study was to compare the peculiarities of maxillofacial injuries caused by interpersonal violence with other etiologic factors.

MATERIAL AND METHODS

Medical records of 3,724 patients with maxillofacial injuries in São Paulo state (Brazil) were retrospectively analyzed. The data were submitted to statistical analysis (simple descriptive statistics and Chi-squared test) using SPSS 18.0 software.

RESULTS

Data of 612 patients with facial injuries caused by violence were analyzed. The majority of the patients were male (81%; n = 496), with a mean age of 31.28 years (standard deviation of 13.33 years). These patients were more affected by mandibular and nose fractures, when compared with all other patients (P < 0.01), although fewer injuries were recorded in other body parts (χ(2) = 17.54; P < 0.01); Victims of interpersonal violence exhibited more injuries when the neurocranium was analyzed in isolation (χ(2) = 6.85; P < 0.01).

CONCLUSIONS

Facial trauma due to interpersonal violence seem to be related to a higher rate of facial fractures and lacerations when compared to all patients with facial injuries. Prominent areas of the face and neurocranium were more affected by injuries.

Violence-related facial trauma: analysis of multidetector computed tomography findings of 727 patients

OBJECTIVES

The multidetector CT (MDCT) findings of facial trauma in victims of interpersonal violence were assessed.

METHODS

All MDCT requests for suspected facial injury during a 62 month period were retrieved; 727 cases met the inclusion criteria. Images were interpreted by two researchers by consensus.

RESULTS

Of the 727 patients (aged 15-86 years old, mean 37), 583 (80.2%) were male and 144 (19.8%) female. Of all the patients, 74% had a fracture, and of these 44% had multiple non-contiguous fractures.

CONCLUSIONS

Violence is a very common cause of facial injury. Nasal and orbital fractures predominate. Males are more often involved; they are younger, sustain fractures more often and significantly more often present with high-energy fracture patterns. LeFort fractures are often unilateral or asymmetrical, and are frequently accompanied by other, clinically significant fractures. Up to 25% of patients with fractures do not have paranasal sinus effusions.

Interpersonal violence and facial fractures

PURPOSE

Interpersonal violence is a major health hazard that contributes to the high volume of trauma seen in the emergency department. It is also one of the principal causes of maxillofacial fractures.

MATERIALS AND METHODS

The present study was a retrospective analysis of patients referred to, and treated at, the Oral and Maxillofacial Surgery Unit at Christchurch Hospital during an 11-year period (1996 to 2006). The variables examined included patient demographics, fracture types, mode of injury, and treatment delivered.

RESULTS

An increase was found in the number of fractures due to interpersonal violence in the second half of the study, although the proportion remained the same. The age of the patients ranged from 9 to 89 years (mean 28). The male-to-female ratio was 9:1. Of the patients, 87% had alcohol involvement. The mandible was the most common site of fracture, followed by the zygoma. Other midface fractures, including Le Fort fractures, were less frequently observed. Of the patients, 59% were hospitalized and 56% required surgery, with internal fixation necessary in 41% of patients.

CONCLUSION

An increase occurred in the number of facial fractures associated with interpersonal violence during the study period. Young male adults were the most affected demographic group, with alcohol a main contributing factor. Violence-related facial fracture is a health hazard that deserves more public awareness and implementation of preventive programs.

Trend of alcohol involvement in maxillofacial trauma

BACKGROUND

Ethanol is regularly consumed by individuals in social settings. However, overindulgence can lead to impaired judgment and physical harm. This study examines the trend of alcohol-related facial fractures at a tertiary trauma over 2 consecutive time periods.

STUDY DESIGN

A retrospective database of patients presenting to the Oral and Maxillofacial Surgery service at Christchurch Hospital during an 11-year period was reviewed, and data from the 2 5.5-year periods were compared. Variables examined included demographics, type of fractures, mode of injury, and treatment delivered.

RESULTS

A total of 1,264 patients were identified to have alcohol-related facial fractures, 624 in the first half of the period and 640 in the second half. More than 90% were male, with 66% of these patients in the 15-29-year age group in each period. Assault accounted for 73% in the first period and 82% in the second period, and motor vehicle accidents accounted for 18% and 8% of fractures, respectively, in the two periods. A total of 64% and 58% of these patients required hospital admission and surgery, respectively, in the first period, and 66% were hospitalised and 60% treated surgically in the second period.

CONCLUSION

There was no significant change between the 2 periods in terms of demographics, pattern of fractures, and treatment modality. The incidence of assault-related fractures were on the rise and motor vehicle accident-related fractures were declining. Alcohol-related fractures continued to be the main problem in young male adults involved in fights. There should be public awareness to educate these people on this harmful effect of drinking.

[Social vulnerability is more frequent in victims of interpersonal violence: value of the EPICES score]

OBJECTIVES

To evaluate social vulnerability of victims of interpersonal violence having consulted a service of forensic medicine with an individual index of social vulnerability.

POPULATION AND METHODS

The population of victims of interpersonal violence was composed of 275 subjects having consulted the service of forensic medicine of the CHU of Saint Etienne. The social data were collected by questionnaire. Social vulnerability was measured by an individual index (EPICES) calculated on the basis of 11 weighted questions related to material and social deprivation. This population was compared with a reference population; the reference population was people, aged more than 16, living in the Rhône-Alpes region and examined in 2005 in one of the Health examination Centres (HECs) of the French General Health Insurance System, that is 7553 men and 6002 women. The comparisons between the two populations were made after redressing the population of the HECs on various socio-demographic data of the Rhône-Alpes region. The relations between violence and the variables studied were measured by odds ratios adjusted on age and sex.

RESULTS

The population of the victims of violence is younger than the reference population (p<0.001). It is characterized by a lower level of education (p<0.001, 15% in the higher education level vs 23%) and the categories Employees and Manual workers are more frequent (p<0.001). The situation with respect to employment is also different between the two populations, unemployment rate is higher (OR=2.25) and the retired are fewer (OR=0.41). Subjects in social vulnerability are more frequent in the victims (57% vs 36%). All these differences persist after adjustment on age and sex. The context in which the aggression took place (family, public area or at work) varies significantly according to social vulnerability. On the other hand, the majority of the other medico-legal characteristics are not different according to the level of social vulnerability.

CONCLUSION

The population of the victims of interpersonal violence has a socio-economic profile different from the reference population. Social vulnerability is associated with interpersonal violence, in particular with violence in the public and family area.

Predictors of injurious assault committed during or after drinking alcohol: a case-control study of young offenders

Studies of causal links between alcohol and aggression are often handicapped by threats to internal and external validity. Case-control methods employ an event-level analysis that can reduce some of these validity threats by the use of within-subject controls. This study used a case-control approach, asking 39 male inmates in a Young Offenders' Institution to compare drinking behaviour before incidents where they reported commission of an injurious assault and a matched incident where they did not. After controlling contextual differences, participants reported personally drinking more heavily and heavier drinking within their group, but not being more impaired when an assault was committed. The assault incidents were more likely to involve spontaneous, rather than planned, drinking and a higher proportion of males in the group. They were less likely to involve drinking in a pub. Our confirmation of previous findings using a case-control methodology strengthens those findings. Limitations of this methodology are also discussed.

Non-firearm weapon use and injury severity: priorities for prevention

OBJECTIVES

To test the hypothesis that weapon-related violence (excluding firearms) results in more severe injury relative to the use of body parts (fists, feet and other body parts), and to rank order of injury severity by assault mechanism.

DESIGN

Retrospective cohort study.

PARTICIPANTS

24,660 patients who were treated in a UK emergency department for violence-related injury.

MAIN OUTCOME MEASURE

Score on the Manchester Triage Scale.

RESULTS

The use of a weapon resulted in significantly more serious injury (adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI) 1.00 to 1.28). However, of all mechanisms of violent injury, the use of feet resulted in most severe injury (AOR 1.41, 95% CI 1.17 to 1.70), followed by blunt objects (AOR 1.35, 95% CI 1.14 to 1.58), other body parts (AOR 1.22, 95% CI 1.06 to 1.40) and sharp objects (AOR 1.09, 95% CI 0.91 to 1.5), compared with use of fists.

CONCLUSIONS

Use of weapons resulted in more severe injury than use only of body parts. The use of feet caused the most serious injuries, whereas the use of fists caused the least severe injuries. Injury severity varied by number of assailants and age of the patient--peaking at 47 years--but not by number of injuries. Preventing the use of feet in violence, and preventing group violence should be major priorities.

Linkage of ambulance service and accident and emergency department data: a study of assault patients in the west midlands region of the UK

OBJECTIVE

The objectives of this study are to determine whether it is possible to link ambulance service and Emergency Department (ED) data for assault patients, to look at the potential advantages of this linkage and to investigate the quality of coding in the two data sets.

DATA AND METHODS

Data from West Midlands Ambulance Service and seven EDs in the urban West Midlands were linked using probabilistic linkage. The linked data were analysed to investigate demography, priority category, diagnosis, conscious level, disposal and assault coding.

PRINCIPAL FINDINGS

84.2% of the ambulance records were linked to an ED record. Only 40.7% of the linked records were coded as assault in the ED data and only 46.7% of ED assault cases brought by ambulance could be linked. 77.6% of all assault injuries were to the head, face and neck. Only 1.0% of patients presented with coma. 12.0% of all assault patients and 53.5% of the highest priority cases were admitted.

CONCLUSIONS

Data linkage is possible and can increase the amount of information available. Data quality problems were identified in both datasets, which has implications for the monitoring and prevention of assaults. The use of a common identifier would aid the following of patient pathways.