Safety in Numbers

Thirty-eight percent of all firearm deaths and injuries are sustained by children and young adults, according to data from the Centers for Disease Control and Prevention. Often, the only medical intervention this population receives is in the emergency department at the time of injury: too little, and far too late. In response, Jason Goldstick (Ph.D. 2010), research assistant professor in emergency medicine, and his team developed the SaFETy score, a new clinical tool to assess firearm violence risk that could help medical professionals better administer preventive services. 

Using data collected from the Flint Youth Injury (FYI) study — helmed by Rebecca Cunningham, M.D. (Residency 1999), professor of emergency medicine, associate vice president for research-health sciences in the Office of Research, and director of the U-M Injury Center — a 10-point scale was developed that demonstrated clear ability to predict future firearm violence involvement. The findings were published recently in the Annals of Internal Medicine. 

Medicine at Michigan spoke with Goldstick about the SaFETy score. This interview has been edited for length and clarity. 

How did you and your team develop the SaFETy score? 

We developed the score using predictive modeling methods applied to data collected during the FYI study, which included 349 assault-injured emergency department (ED) entrants, and 250 non-assault-related ED entrants. Using survey measurements taken during ED visits, we determined a set of variables to gauge future firearm risk. The derived 10-point score relies on four pieces of information: frequency of Serious physical fighting in the past six months, number of Friends that carry weapons, frequency of hearing gunshots in your Environment/ neighborhood in the past six months, and frequency of received gun violence Threats in the past six months. Together, they create the mnemonic "SaFETy," and the resulting score acts as a risk gradient for future gun violence. Our analysis showed that score levels of 0, 1–2, 3–5, 6–8, and 9–10 each corresponded to increasing levels of risk.

What was your goal in creating SaFETy? 

Urban EDs have been identified as critical access points for identifying and intervening in high-risk and difficult-to-reach populations, and have been successfully used for previous violence-prevention programs. However, a reliable basis for gauging risk of future firearm violence has been missing, particularly among those who arrive at the ED for non-violent injuries. 

How were data collected in the FYI study? 

The FYI study was a longitudinal study of drug-using youth arriving at a Flint ED. Assault-injured youth (ages 14–24) were eligible for screening. For control purposes, the next available non-assault-injured youth of the same gender and comparable age was approached for screening. Those reporting any substance use during the past six months were eligible, and were administered a comprehensive baseline survey; individuals were re-contacted after six-, 12-, 18-, and 24-months for reassessment. Instances of gun violence involvement during the follow-up period were determined from a combination of survey data, self-reported data, and medical chart review. 

How do your results differ from the conventional wisdom in this area? 

The prior convention for gauging future violence risk was to look at the reason for the ED visit, which only included people with violent injury. One thing we showed in the paper was that the SaFETy score outperformed this method — specifically, whether or not the index visit was due to a violent injury — as a predictive factor for future firearm violence. Importantly, this suggests that the SaFETy score provides a previously unavailable means for gauging risk among those who arrived at the ED for non-violence-related reasons. 

Why would a new clinical screening tool be useful? 

SaFETy can be quickly administered, improves upon previous tools, and provides a basis for risk assessment among non-violently-injured youth. Developing an ED/hospital-based clinical screening tool will enable EDs to better focus prevention resources on patients with the highest risk. In addition, the SaFETy score is the only violence screening tool that specifically focuses on firearm violence. 

What are the next steps for SaFETy? 

We hope for opportunities to externally validate the score and to determine how it can be modified to suit different populations by applying similar analyses to other data.