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Study Objective: We assess the feasibility of evaluating acute stress disorder (ASD) symptoms in the emergency department and provide an initial estimate of the prevalence, severity, and variability of these symptoms in violently injured urban children and young adults., Methods: The Immediate Stress Response Checklist (ISRC) was administered to violently injured patients between the ages of 8 and 24 years who presented to 2 urban, academic medical center EDs during a 10-week period. The ISRC is designed to assess ASD symptoms in children and youths immediately after a traumatic event. Responses are described using summed symptom severity scores and counts of symptoms., Results: Out of 109 identified youths, 81 participated. Fear, helplessness, or horror during the injury event was reported by 59 (73%) of study participants. Each of the following categories of ASD symptoms was reported by a significant number of youths: peritrauma dissociation, 63 (78%); posttrauma dissociation, 33 (41%); re-experiencing intrusive thoughts or images, 66 (82%); avoidance, 53 (65%); and hyperarousal, 32 (39%). The ISRC demonstrated high internal consistency (Cronbach alpha=.88) in this cohort., Conclusion: The ISRC can be used to assess acute stress reactions in violently injured youths in the immediate period after injury. Although these reactions appear to be common, there is substantial variability among distinct symptom categories. These results support the need for further investigation of the relationship between immediate stress responses and longer-term emotional impact of violent injury. Clinicians should consider assessing the emotional responses of children and adolescents who are injured by interpersonal violence, even when these injuries seem minor.

Objective: To determine what percentage of women presenting to an urban emergency department (ED) for any reason had been the victims of violence committed by another woman in the previous year., Methods: This was a prospective study of a consecutive sample of female patients of legal age presenting to the ED between 8 AM and 12 midnight over an 11-week period. Patients were asked a series of questions adapted from the George Washington University Universal Violence Prevention Screening Protocol. Non-English-speaking patients, those unable to give informed consent, and those meeting regional criteria for major trauma were excluded., Results: One thousand six hundred seventy-six women participated; 426 (25%) refused. Of the 1,250 women interviewed, 118 (9.4%; 95% CI = 7.8% to 11.1%) reported being assaulted by another woman in the previous 12 months. Compared with the nonvictims, the victims were more frequently younger and single. The most common forms of assault were slapping, grabbing, and shoving (54.7% of victims). These were followed by being choked, kicked, bitten, or punched (46.2%). Eighteen percent of the assaults involved a weapon or an object. Five percent of the victims described being forced to have sex. Thirty-seven percent of the victims contacted the police, 13% required medical attention, 17% pursued legal action, and 10% sought follow-up counseling., Conclusions: Nine percent of the women in the study sample had been assaulted by another woman in the previous year. Further attention to the recognition and management of violence committed by women against other women may be warranted to ensure that patients receive appropriate treatment and referral.

Objective: To assess emergency department (ED) clinicians' attitudes and behaviors regarding identification, assessment, and intervention for youth at risk for violence in the ED., Design: Anonymous, cross-sectional written questionnaire., Setting: The EDs of 3 urban hospitals., Subjects: Emergency medicine residents and faculty, pediatric residents, pediatric emergency medicine fellows and faculty, and ED nurses., Results: A total of 184 (88%) of 208 clinicians completed the questionnaire. Only 15% correctly recognized the lack of existing protocols for addressing youth violence. Clinicians reported being most active in identification of at-risk youth (93% asking context of injury and 82% determining relationships of victim and perpetrator), with pediatricians being more active than general ED clinicians (87% vs 68%; P<.01). Clinicians less often reported performing assessments or referrals of at-risk youth. Nurses and physicians were no different in their reported identification, assessment, or referral behaviors. Barriers identified include concern over upsetting family members, lack of time or skills, and concern for personal safety. Additional clinician training, information about community resources, and specially trained on-site staff were noted by respondents as potential solutions., Conclusions: Emergency department clinicians recognize the need for evaluation of youth at risk for violence. They are able to identify violently injured youth, but less often perform risk assessment to guide patients to appropriate follow-up resources. Further investigation should address clinician barriers to the complete care of violently injured youth in the ED.