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Linking emergency care and police department data to strengthen timely information on violence-related paediatric injuries
  1. Jennifer Hernandez-Meier1,
  2. Zengwang Xu2,
  3. Sara A Kohlbeck3,
  4. Michael Levas4,
  5. Jonathan Shepherd5,
  6. Stephen Hargarten1
  1. 1 Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  2. 2 Geography, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
  3. 3 Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  4. 4 Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  5. 5 Crime and Intelligence Innovation Institute, Cardiff University, Cardiff, UK
  1. Correspondence to Dr Jennifer Hernandez-Meier, Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; jhernandez{at}


Background Combined ED and police department (PD) data have improved violence surveillance in the UK, enabling significantly improved prevention. We sought to determine if the addition of emergency medical service (EMS) data to ED data would contribute meaningful information on violence-related paediatric injuries beyond PD record data in a US city.

Methods Cross-sectional data on self-reported violence-related injuries of youth treated in the ED between January 2015 and September 2016 were combined with incidents classified by EMS as intentional interpersonal violence and incidents in which the PD responded to a youth injury from a simple or aggravated assault, robbery or sexual offence. Nearest neighbour hierarchical spatial clustering detected areas in which 10 or more incidents occurred during this period (hotspots), with the radii of the area being 1000, 1500, 2000 and 3000 ft. Overlap of PD incidents within ED&EMS hotspots (and vice versa) was calculated and Spearman’s r tested statistical associations between the data sets, or ED&EMS contribution to PD violence information.

Results There were 935 unique ED&EMS records (ED=381; EMS=554). Of these, 877 (94%) were not in PD records. In large hotspots >2000 ft, ED&EMS records identified one additional incident for every three in the PD database. ED and EMS provided significant numbers of incidents not reported to PD. Significant correlations of ED&EMS incidents in PD hotspots imply that the ED&EMS incidents are as pervasive across the city as that reported by PD. In addition, ED and EMS provided unique violence information, as ED&EMS hotspots never included a majority (>50%) of PD records. Most (676/877; 77%) incidents unique to ED&EMS records were within 1000 ft of a school or park.

Conclusions Many violence locations in ED and EMS data were not present in PD records. A combined PD, ED and EMS database resulted in new knowledge of the geospatial distribution of violence-related paediatric injuries and can be used for data-informed and targeted prevention of violence in which children are injured—especially in and around schools and parks.

  • violence
  • interpersonal
  • pediatrics
  • pediatric emergency medicine
  • pediatric injury

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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  • Handling editor Mary Dawood

  • Twitter @JHernandezMeier

  • Presented at The results of this study were presented in part at the 2017 Meeting of the Society for Advancement of Violence and Injury Research, 19 September 2017, Ann Arbor, Michigan, and the 2016 International Association of Crime Analysts Training Conference, 21 September 2016, Louisville, Kentucky.

  • Contributors JH-M is guarantor. JH-M and ZX had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: JH-M, SH and JS. Acquisition, analysis or interpretation of data: JH-M, ZX, SAK and ML. Statistical analysis: ZX. Obtained funding: JH-M and SH. Study supervision: JH-M and SH.

  • Funding This project was supported by award numbers 2014-IJ-CX-0110 and 2018-AR-BX-K106, awarded by the National Institute of Justice and the Bureau of Justice Assistance, Office of Justice Programs, US Department of Justice.

  • Disclaimer The opinions, findings, and conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect those of the Department of Justice. The funder had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.