What is the problem and what is known about it so far?
Young adults seen in the emergency department are at increased risk for firearm violence, either as victim or shooter. However, there is no validated way to screen young adults in the emergency department for their risk for future firearm violence.
Why did the researchers do this particular study?
The researchers previously developed a promising tool called the SaFETy score to screen young adults for future firearm violence. The score is based on 4 questions about fighting frequency, hearing gunshots in one’s neighborhood, how often one was threatened by a firearm in the past 6 months, and how many friends carry weapons. To examine its usefulness as a clinical screening tool, the researchers conducted a study in emergency departments in 3 cities.
Who was studied?
This 12-month study recruited people aged 18 through 24 years who were seen in 1 of 4 emergency departments in 3 cities: Seattle, Philadelphia, and Flint. Potential participants visited the emergency department for any reason. They excluded people in police custody, those with serious psychiatric conditions or sexual assault, and those who could not give consent.
How was the study done?
At the time of the initial emergency department visit, participants answered the 4 SaFETy score questions and other questions, such as substance use, alcohol use, depression, anxiety, posttraumatic stress, and any firearm violence in the prior 6 months. Participants were then surveyed 6 and 12 months later about firearm violence. Medical records also identified study participants with any emergency department visits for a firearm injury in the subsequent 12 months.
What did the researchers find?
Of 1506 participants, 1122 (74.5%) had information about future firearm violence and, of these, 73 (6.5%) did have firearm violence as the shooter or victim. The proportion of participants with firearm violence increased with higher SaFETy scores. A SaFETy score of 1 or more was a good screening test for risk for future firearm violence, but a score of 4 or more worked best to identify true positives. The SaFETy score increased the ability to identify people at risk for firearm violence when added to other factors, including personal, intrusive questions.
What were the limitations of the study?
The score is self-reported, so it might not be accurate, and information about future firearm violence was missing for one fourth of the participants.
The study found that the brief SaFETy score predicts the risk for future firearm violence in young adults seen for any reason in the emergency department. Future studies may use this score to target interventions to reduce this risk in young people.
View this summary as published by the Annals of Internal Medicine
View the coinciding Tip Sheet drafted by the Annals of Internal Medicine
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