Hospital-based violence intervention programs targeting adult populations: an Eastern Association for the Surgery of Trauma evidence-based review

Abstract

BackgroundViolent injury and reinjury take a devastating toll on distressed communities. Many trauma centers have created hospital-based violent injury prevention programs (HVIP) to address psychosocial, educational, and mental health needs of injured patients that may contribute to reinjury.ObjectivesTo evaluate the overall effectiveness of HVIPs for violent injury prevention. We performed an evidence-based review to answer the following population, intervention, comparator, outcomes (PICO) question: Are HVIPs attending to adult patients (age 18+) treated for intentional injury more effective than the usual care at preventing: intentional violent reinjury and/or death; arrest and/or incarceration; substance abuse and/or mental issues; job and/or school attainment?Data sourcesPubMed, Web of Science, Google Scholar, and the Cochrane Library were queried for salient articles by a professional librarian on two separate occasions, and related articles were identified from references.Study eligibility criteria, participants, interventionsEligible studies examined adult patients treated for intentional injury in a hospital-based violence prevention program compared to a control group.Study appraisal and synthesis methodsWe used the Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the evidence.Results71 articles were identified. After discarding duplicates, reviews, and those articles that did not address our PICO questions, we ultimately reviewed 10 articles. We found insufficient evidence to recommend adult-focused HVIP interventions.LimitationsThere was a relative paucity of data, and available studies were limited by self-selection bias and small sample sizes.ConclusionsWe make no recommendation with respect to adult-focused HVIP interventions.

What Is the Institutional Duty of Trauma Systems to Respond to Gun Violence?

“…Additionally, we discuss the use of hospital-based violence intervention (HBVI) programs as a preventive strategy designed to break the cycle of violence and reduce trauma recidivism, which is associated with an increased risk of long-term mortality in the trauma population [1]. Although several small studies suggest that HBVI programs successfully reduce trauma recidivism, scholars argue that obtaining high-quality evidence of their effectiveness will be challenging, if not impossible, given difficulties related to studying the trauma population [2]. Rather than waiting for sufficient evidence regarding their effectiveness, we argue for implementation of HBVI programs within trauma centers.…”

“…HBVI programs have been implemented with success; however, these data are limited to single-institution studies [2], which have shown dramatic reductions in trauma recidivism, health care expenses, and mortality of participants [29,30]. Aside from a handful of urban trauma centers [2], most have yet to adopt HBVI programs, citing a need for stronger evidence of their benefits and cost effectiveness. Unfortunately, an evidenced-based review of the literature failed to show significant benefits of these programs, citing high risk of bias, low quality of evidence, and heterogeneity among programs studied [2].…”

“…Aside from a handful of urban trauma centers [2], most have yet to adopt HBVI programs, citing a need for stronger evidence of their benefits and cost effectiveness. Unfortunately, an evidenced-based review of the literature failed to show significant benefits of these programs, citing high risk of bias, low quality of evidence, and heterogeneity among programs studied [2]. The authors also offer a number of more specific criticisms of these studies.…”

“…The authors also offer a number of more specific criticisms of these studies. They suggest that current measures of programmatic success do not fully account for indicators of value such as the patient's experience [2]. Notably, the population most affected by interpersonal violence presents unique challenges for collecting accurate longitudinal data, as loss to follow up is common given participants' high mortality, limited access to health care, and intersections with the criminal justice system [2].…”

“…They suggest that current measures of programmatic success do not fully account for indicators of value such as the patient's experience [2]. Notably, the population most affected by interpersonal violence presents unique challenges for collecting accurate longitudinal data, as loss to follow up is common given participants' high mortality, limited access to health care, and intersections with the criminal justice system [2]. Moreover, some institutional review boards have prohibited randomized controlled trials to test the effectiveness of HBVI programs on ethical grounds [2].…”