SAFETY SCORE

SaFETy Score Predicts Risk for Firearm Violence in Substance-Using Youth

Katherine Bakes, MD reviewing Goldstick JE et al. Ann Intern Med 2017 Apr 11.

Each 1-point increase in the 10-point SaFETy score was associated with increased risk for future firearm violence.

In a prospective longitudinal study of substance-using youth 14 to 24 years of age presenting to a Flint, Michigan, emergency department (ED), investigators developed and validated a clinical screening tool for predicting the risk for future firearm violence.

Of 599 youth enrolled (average age, 20 years), 252 (42%) were involved in firearm violence during the 24-month follow-up period. To develop the 10-point SaFETy score, the investigators selected four variables (based on breadth and clinical feasibility) from among those most predictive of future firearm violence:

• Serious fighting in the past 6 months (score, 0–4, depending on frequency
• Friend weapon carrying (0−1, depending on number of friends)
• Community Environment (0–1, depending on frequency of having heard gun shots in past 6 months)
• Firearm Threats (0–4, depending on how often someone pulled a gun on the youth in the last 6 months)

Each 1-point increase in the SaFETy score was associated with an increase in the risk for future firearm violence (odds ratio, 1.5), even after adjusting for reason for the ED visit (OR, 1.4). A SaFETy score of 8 or more was 100% specific for predicting risk for future firearm violence.

COMMENT

These investigators succeeded (with an impressive 81% follow-up rate) at creating a relatively simple tool to assess risk for future firearm violence among substance-using youth. Although this tool should be externally validated, it has clear applicability for many communities suffering from firearm violence. Utilizing evidence-based strategies like this allows for targeted ED interventions and judicious deployment of limited intervention resources.