University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Emergency Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Emerg Med J. 2020 Aug;37(8):489-495. doi: 10.1136/emermed-2019-208970. Epub 2020 Jun 17.
Community violence bears significant human and economic costs. Furthermore, victims requiring ED treatment are at a greater risk of violent reinjury, arrest due to perpetration and violent death. We aimed to evaluate the effectiveness of ED-based violence intervention programmes (EVIPs), which aim to reduce future violence involvement in these individuals.
We performed a systematic literature review searching MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, The Cochrane Library and Web of Science, in addition to hand-searching. Randomised controlled trials (RCTs) were included if they enrolled victims of community violence requiring ED treatment, evaluated interventions taking place in the ED and used violent revictimisation, arrests or intermediate outcome measures as endpoints. We included trials that had a Jadad score of 2 or above.
297 records were identified, and 13 articles were included in our final qualitative analysis, representing 10 RCTs and 9 different EVIPs. The risk of selection bias was low; the risk of performance, detection and attrition bias was moderate. 9 out of 13 papers reported statistically significant improvements in one or more outcome measures related to violence, including violent reinjury and arrests due to violence perpetration.
The results of this literature review show that EVIPs may be capable of reducing violent reinjury and arrests due to violence perpetration. Larger RCTs, taking place in different regions, in different age groups and using different techniques, are justified to determine which conditions may be required for success and whether EVIPs are generalisable.
社区暴力带来了巨大的人力和经济成本。此外，需要接受急诊治疗的受害者再次遭受暴力的风险更高，因施暴而被捕和死于暴力的风险也更高。我们旨在评估以急诊为基础的暴力干预项目（EVIP）的有效性，这些项目旨在减少这些人未来的暴力参与。
我们进行了系统的文献回顾，搜索了 MEDLINE、Embase、护理学和联合健康文献累积索引、PsycINFO、Cochrane 图书馆和 Web of Science，此外还进行了手工检索。如果随机对照试验（RCT）招募了需要急诊治疗的社区暴力受害者，评估了在急诊室进行的干预措施，并将暴力再受害、逮捕或中间结果作为终点，我们将其纳入。我们纳入了 Jadad 评分为 2 或以上的试验。
共确定了 297 条记录，最终定性分析纳入了 13 篇文章，代表了 10 项 RCT 和 9 种不同的 EVIP。选择偏倚的风险较低；实施、检测和失访偏倚的风险为中度。13 篇论文中有 9 篇报告了与暴力相关的一个或多个结局指标的统计学显著改善，包括暴力再受伤和因暴力犯罪而被捕。
本文献回顾的结果表明，EVIP 可能能够减少暴力再受伤和因暴力犯罪而被捕。在不同地区、不同年龄组和使用不同技术的更大规模 RCT 是合理的，以确定成功所需的条件以及 EVIP 是否具有普遍性。
