November 13, 2018 / 10:30 PM / 10 months ago

Most violent injuries seen in ER not reported to police

(Reuters Health) - The vast majority of violent injuries seen by doctors in emergency rooms are not reported to police, a new report suggests.

Researchers looking at violent injuries treated in emergency rooms in the metropolitan Atlanta area found that fewer than two in 10 were reported to law enforcement, according to the study in JAMA Internal Medicine.

“This single institution study suggests that a remarkable number of injuries due to violence are not getting reported at all,” said Dr. Albert Wu, an internist and professor of health policy & management at the Johns Hopkins Bloomberg School of Public Health. “This may be leading us to underestimate the extent of the problem and to underestimate the need and the budget needed to prevent future violence.”

Wu, who was not involved in the new research, commented by email.

The numbers reported in the new study appear to exceed those found by the U.S. Department of Justice’s National Crime Victim Survey, which indicated that 52.6 percent of violent crimes resulting in injury go unreported to law enforcement.

To get a sense of how many violent injuries never got reported to police, an urban emergency department with a level 1 trauma designation and two urban police departments in the Atlanta metro area collaborated to pool their data. From the hospital side, nurses interviewed patients who came into the ER with violent injuries, asking for the location and date and time of the incident that resulted in the injury. The nurses collected location information only when the incident occurred in a public place; to protect the privacy of the patients, no information was collected on violence occurring in private residences.

When the hospital’s list of violent injuries was compared with incidents that had been reported to the police, it turned out that a large number had never come to the attention of law enforcement, according to Dr. Steven Sumner of the Centers for Disease Control and Prevention in Atlanta and colleagues.

Between November 20, 2015 and May 4, 2017, 1,654 violent injuries were identified by the nurses and 67.8 percent of those, or 1,122, occurred in a public location. Among the incidents that occurred within the two cooperating police jurisdictions - identified in the study only as A and B - just a small percentage turned out to have been reported to law enforcement. The percentage that went unreported to police was 83.2 percent in jurisdiction A and 93.1 percent in B.

The new study offers a window on violence that is rarely available, said Steven Albert, a professor of behavioral and community health science at the Graduate School of Public Health at the University of Pittsburgh.

“The brilliance of this article is it shows that if we do not link these two kinds of data we’re never going to have a full and accurate account of the level of violence in a community,” said Albert, who was not involved in the study. “The vast majority of injuries are not known to police. Patients show up in the emergency department battered in some way and may or may not have had any contact with the police.”

Albert suspects that the numbers found by the researchers underestimate the actual number of violent injuries. “I suspect a number of people who have severe but not life-threatening injuries never go to the hospital,” he explained. “They may have someone who patches them up at home and we might never know about them even if the emergency room data are linked to the police data.”

Wu can see possible downsides to programs like the one described in the new article.

While merging anonymous data from ERs with police information might give a lot of insight, there could problems, Wu said in an email. “We don’t want to discourage people from going to the emergency department,” he said.

SOURCE: JAMA Internal Medicine, online November 12, 2018.

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