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Report of a Large Concurrent Case-control Study

Carnell Cooper, MD; Dawn Eslinger, MS; Denis Nash, PhD, MPH; Jalal Al Zawahri, MD; Paul Stolley, MD, MPH

Arch Surg. 2000;135:837-843.

Hypothesis  Repeat victims of violence (violence victim recidivism) is a phenomenon known throughout the nation by those who work in hospital emergency departments. A level I trauma center in Baltimore, Md, conducted this study to investigate the postulated risk factors for repeat victims of violence, ie, unemployment, limited educational attainment, and involvement with illicit drug use or drug dealing.

Design  A case-control study identified 200 cases and 224 controls during a 16-month period. Cases were persons admitted with traumatic injury secondary to violent assault who had been previously hospitalized for a similar reason. Controls were a random selection of eligible age- and sex-matched patients admitted for reasons unrelated to violent injury.

Results  Prominent risk factors associated with recidivism were African American male, median age 31 years, unemployed, lacking medical insurance, annual income less than $10,000, current drug user, past or present drug dealer, and a positive test for psychoactive substances on admission to the hospital. One hundred seventy-two (86%) of the cases felt that disrespect (called "dissing" in the local vernacular) was involved with their injury.

Conclusions  The multiplicity of risk factors and the fact that they are interrelated mandate a comprehensive approach to the difficult problem of violence recidivism. Experiments in hospital-based intervention strategies are needed.

From the University of Maryland Medical System, Department of Surgery and the R. Adams Cowley Shock Trauma Center (Dr Cooper); the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine (Ms Eslinger, and Drs Nash and Stolley); and the University of Maryland Medical System–National Study Center for Trauma and Emergency Medical Systems (Dr Zawahri), Baltimore. The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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