Query purpose:
Youth violence is the intentional use of physical force or power to threaten or harm others by young people ages 10-24.1 It typically involves young people hurting peers who are unrelated to them and who they may or may not know well.2 It includes fighting, bullying, threats with weapons, and gang-related violence. A young person can be involved with youth violence as a victim, offender, or witness. The syndromic definition for Youth violence does not include sexual violence, intimate partner violence, emotional abuse, family violence, or child abuse/neglect by a parent or family member (definitions to capture these types of violence can be found in ESSENCE). The goal of this syndrome definition is to assist state, local, tribal, territorial, and federal public health practitioners in standardizing, identifying, and monitoring youth violence-related emergency department (ED) visits using syndromic surveillance data. The syndrome definition can improve states and communities’ understanding of trends in youth violence-related ED visits, which can inform timely prevention and response efforts.
How it was developed:
The definition's authors, including subject matter experts from the CDC’s Division of Violence Prevention, worked with four jurisdictions (Arizona, Alaska, Kentucky, and New Mexico) to test and validate it using visit data from January to December 2022.
- The team assessed the chief complaint terms in other violence-related syndrome definitions for inclusion/exclusion in the definition.
- The team added additional diagnosis codes and chief complaint terms related to violence not included in other violence-related definitions.
- Participating jurisdictions computed the sensitivity of the definition using case-based surveillance data. Multiple sub-versions of the definition were iteratively analyzed and refined until the current definition (described in detail below) was finalized.
How it works:
The Chief Complaint Discharge Diagnosis (CCDD) field is used to query both the discharge diagnosis codes and chief complaint free text with exclusions (as necessary) to develop the syndrome definition.
It is important to note that youth violence occurs in individuals ages 10-24. As such, this specific age range should be entered into the query, or the NCHS Age Grouping preset categories should be used (select both 11-14 AND 15-24).
When running this definition, the following existing definitions in ESSENCE must be excluded:
- Sexual Violence v1
- Sexual Violence v2
- CDC Sexual Violence v3
- CDC Suspected Child Abuse and Neglect v1
- Intimate Partner Violence v1
- CDC Intimate Partner Violence v2
- CDC Suicide Attempt v1
- CDC Suicidal Ideation v1
This may be done by adding the following to “CCDD category free text” field:
ISNULL,or,^,ANDNOT,(,^Sexual Violence v[123]^,or,^;CDC Suspected Child Abuse and Neglect v1;^,or,^;Intimate Partner Violence v1;^,or,^;CDC Intimate Partner violence v2;^,or,^;CDC Suicide Attempt v1;^,or,^CDC Suicidal Ideation v1;^,)
Visits are classified as youth violence-related if:
- The discharge diagnosis field includes an “included” code, even if the chief complaint is not specific to youth violence
- For example, if a discharge diagnosis code is violence-related (e.g., ICD-10-CM Y04, assault by bodily force) but the chief complaint does not include violence-related terms (e.g., shortness of breath)
OR
- For example, if a discharge diagnosis code is violence-related (e.g., ICD-10-CM Y04, assault by bodily force) but the chief complaint does not include violence-related terms (e.g., shortness of breath)
- The chief complaint includes a term specific to youth violence, but the discharge diagnosis field does not contain an included code
- For example, if a chief complaint includes “patient was assaulted,” but there is not a discharge diagnosis code indicating a violence-related injury
OR
- For example, if a chief complaint includes “patient was assaulted,” but there is not a discharge diagnosis code indicating a violence-related injury
- There is agreement in both the discharge diagnosis field and the chief complaint field that a visit is youth violence-related
- For example, if a chief complaint includes “patient was at the gas station and robbed and then hit on the top of the head with an unknown object,” and there is a corresponding violence-related discharge diagnosis code (e.g., Y09, assault by unspecified means)
For consideration:
This definition has some limitations, including the inability to detect youth violence-related injuries if the specified chief complaint terms or discharge diagnosis codes are not included in the patient visit. Additionally, most patient visits do not provide enough information to determine whether the patient was the perpetrator or the victim of youth violence. Additional violence related chief complaint terms (e.g. hit, cut, kicked) were validated but not included in the definition due to numerous other injuries that are not related to violence. Although true positives are determined based on chief complaints and discharge diagnoses, several states used supplementary fields in ESSENCE, such as triage notes or clinical impressions, to note false positives. This resulted in lower PPVs than classification based only on CCDD data.
(,(,(,^ass[au]lt^,OR,^ass[au][au]lt^,OR,^beat^,ANDNOT,(,^heartbeat^,OR,^heart beat^,OR,^heart is beat^,OR,^difficulty beat^,OR,^beath^,OR,^hrt beat^,OR,^feels beat^,OR,^heart skips^,OR,^extra beats^,OR,^premature beats^,),OR,^beat up^,OR,^beating up^,OR,^beat him^,OR,^beat her^,OR,^beat them^,OR,^beating him^,OR,^beating her^,OR,^beating them^,OR,^catch hands^,OR,^caught hands^,OR,^caught those hands^,OR,^caught a fade^,OR,^threw hands^,OR,(,^fight^,ANDNOT,^play^,),OR,^fought^,OR,(,^altercation^,ANDNOT,^verbal altercation^,),OR,^I was attacked^,OR,^he was attacked^,OR,^she was attacked^,OR,^patient was attacked^,OR,^attacked by^,OR,^brawl^,OR,^pistol whip ^,OR,^pistol whipped^,OR,^pistol whipping^,OR,(,^violence^,OR,^violent^,),ANDNOT,(,^acting^,OR,^threat^,OR,^feel[is]^,),OR,(,^ robbed^,OR,^robbery^,OR,^ robbing^,OR,^robber^,OR,^mugging^,OR,^mugged^,OR,^mugger^,OR,^was jumped^,OR,^they jumped^,OR,^got jumped^,),ANDNOT,(,^no injury^,),),OR,(,^ass[au][au]lt^,),AND,(,(,!gsw!,OR,^gunshot^,OR,^gun shot^,OR,^gunshout^,OR,^gunshoot^,OR,^buckshot^,OR,^buck shot^,OR,^revolver^,OR,^riffle^,OR,^rifle^,OR,^shotgun^,OR,^shot gun^,OR,^firearm^,OR,^fire arm^,OR,^pistol^,OR,^handgun^,OR,^hand gun^,OR,^been shot^,OR,^I was shot^,OR,^I got shot^,OR,(,^struck^,OR,^hit with^,),AND,(,^gun^,OR,^pistol^,),OR,(,(,^hit^,OR,^ricochet^,OR,^graze^,),AND,(,^bullet^,),),OR,(,^gun^,AND,^wound^,),),ANDNOT,(,^no gun^,OR,^remove gun^,OR,^heard gun^,OR,^hearing gun^,OR,^hit head^,OR,^hit my head^,OR,^kickback^,OR,^kick back^,OR,^kicked back^,OR,^water gun^,OR,^watergun^,OR,^pelle^,OR,^pellt^,OR,^ bb ^,OR,^bebe gun^,OR,^bb gun^,OR,^bbgun^,OR,^b b gun^,OR,^bibi gun^,OR,^bi bi gun^,OR,^bb pellet^,OR,^bee bee^,OR,^beebe^,OR,^rubber bullet^,OR,^paint^,OR,^nerf^,OR,^nurf^,OR,^airgun^,OR,^air gun^,OR,^airsoft^,OR,^air soft^,OR,^spring^,OR,(,^nail^,ANDNOT,^damage to nail^,),OR,^nailgun^,OR,^nail gun^,OR,^staplegun^,OR,^staple gun^,OR,^stun^,OR,^ta[sz]er^,OR,^la[sz]er^,OR,^bloodshot^,OR,^blood shot^,OR,^scope^,OR,^fake^,OR,^allergy shot^,OR,^injection^,OR,^follow-up^,OR,^follow up^,OR,^followup^,OR,^chronic^,OR,(,^wound^,AND,(,^check^,OR,^care^,OR,^recheck^,OR,^infection^,OR,^infected^,),),OR,^drainage^,OR,^gswel^,OR,^gswol^,OR,^;Z5189^,),),ANDNOT,(,^selfinflicted^,OR,^self inflicted^,OR,^self caus^,OR,^self harm^,OR,^accident^,OR,^unintent^,OR,^threat^,OR,^ideation^,OR,^;X7[1-9]^,OR,^;X8[0-3]^,),),ANDNOT,(,(,^attacked^,OR,^assaulted by^,OR,^assaulted by^,),AND,(,^sister^,OR,^brother^,OR,^sibling^,OR,^cousin^,OR,^caretaker^,OR,^relative^,OR,^son^,OR,^daughter^,OR,^mother^,OR,^mom^,OR,^father^,OR,^dad^,OR,^nurse^,OR,^friend^,OR,^animal^,OR,^dog^,),),OR,^;X9[2-9]^,OR,^Y0[0-9]^,OR,^;T54[123]X3^,OR,^;T71XX3^,OR,^;E96[0-9]^,OR,^;E979^,OR,^;E9991^,OR,^;242869008;^,OR,^;219199009;^,OR,^;219200007;^,OR,^;219201006;^,OR,^;219204003;^,OR,^;219205002;^,OR,^;219203009;^,OR,^;219198001;^,OR,^;11385001;^,OR,^;219218005;^,OR,^;52684005;^,OR,^;269732008;^,OR,^;219182008;^,OR,^;242856009;^,OR,^;242857000;^,OR,^;219184009;^,OR,^;219181001;^,OR,^;219240001;^,OR,^;219241002;^,OR,^;242872001;^,OR,^;242878002;^,OR,^;242873006;^,OR,^;242874000;^,OR,^;242876003;^,OR,^;242875004;^,OR,^;242886002;^,OR,^;242888001;^,OR,^;242887006;^,OR,^;219197006;^,OR,^;274954001;^,OR,^;219207005;^,OR,^;219213001;^,OR,^;242870009;^,OR,^;219212006;^,OR,^;219214007;^,OR,^;219208000;^,OR,^;242871008;^,OR,^;219209008;^,OR,^;219231000;^,OR,^;219232007;^,OR,^;242921009;^,OR,^;242920005;^,OR,^;219239003;^,OR,^;219191007;^,OR,^;219192000;^,OR,^;219193005;^,OR,^;269734009;^,OR,^;219194004;^,OR,^;219195003;^,OR,^;242868000;^,OR,^;429626008;^,OR,^;429580005;^,OR,^;428498002;^,OR,^;428500001;^,OR,^;428200002;^,OR,^;242930001;^,OR,^;242931002;^,OR,^;242934005;^,OR,^;242933004;^,OR,^;242932009;^,OR,^;242936007;^,OR,^;242935006;^,OR,^;219186006;^,OR,^;219187002;^,OR,^;269733003;^,OR,^;302986003;^,OR,^;242858005;^,OR,^;242859002;^,OR,^;242861006;^,OR,^;242864003;^,OR,^;242860007;^,OR,^;242863009;^,OR,^;219234008;^,OR,^;219235009;^,OR,^;219236005;^,OR,^;242908002;^,OR,^;242913003;^,OR,^;242910000;^,OR,^;242914009;^,OR,^;242911001;^,OR,^;242907007;^,OR,^;242912008;^,OR,^;242909005;^,OR,^;242919004;^,OR,^;219237001;^,OR,^;242924001;^,OR,^;242926004;^,OR,^;242925000;^,OR,^;242927008;^,OR,^;242929006;^,OR,^;242928003;^,OR,^;242923007;^,OR,^;242922002;^,OR,^;242889009;^,OR,^;242903006;^,OR,^;242896006;^,OR,^;242897002;^,OR,^;242895005;^,OR,^;242898007;^,OR,^;242901008;^,OR,^;242900009;^,OR,^;242899004;^,OR,^;242902001;^,OR,^;242894009;^,OR,^;242892008;^,OR,^;242893003;^,OR,^;242905004;^,OR,^;242890000;^,OR,^;242904000;^,OR,^;242891001;^,OR,^;242865002;^,OR,^;242866001;^,OR,^;242867005;^,OR,^;242915005;^,OR,^;242916006;^,OR,^;242918007;^,OR,^;242917002;^,OR,^;219222000;^,OR,^;274229005;^,OR,^;219223005;^,OR,^;50084004;^,),ANDNOT,(,^panic attack^,OR,^anxiety attack^,OR,^asthma attack^,OR,^psychiatric^,OR,^psych eval^,OR,^mental health eval^,OR,^;Z133^,)