Disparities in Reporting of Violent Events by Patients at a US Children’s Hospital

BACKGROUND: Violence toward health care workers is increasing, yet patient risk factors for having a reported violent event (VE) are unknown. Understanding patient risk factors associated with reported VEs is needed to inform equitable approaches to VE reporting and guide resource delivery. OBJECTIVE: To identify patient and hospitalization characteristics associated with reported VEs at a US children's hospital. METHODS: This case-control retrospective study included children aged 5 to 18 that were hospitalized between January 1, 2019 and December 31, 2023 at a 390-bed children's hospital. We identified reported VEs by querying a form in our electronic health record form, which documents violent behaviors by patients. Odds of a reported VE occurrence were modeled as a function of patient and hospitalization characteristics using a multivariable logistic regression model. RESULTS: Among 28 052 youth with 43 991 hospitalizations, 199 youth (0.7%) and 242 hospitalizations (0.6%) had a reported VE. Higher rates of restraint use were observed among children with reported VEs (37.6%) compared with those without reported VEs (0.3%). Age, race, and mental or behavioral health (MBH) diagnosis were associated with adjusted odds of reported VEs. After controlling for other covariates, Black children were at increased adjusted odds ratio (aOR) of reported VEs (aOR 3.64; 95% CI, 2.51-5.27) compared with white children. Many MBH conditions were significantly associated with increased aORs for VEs, with disruptive, impulse control, and conduct disorders (aOR 6.25; 95% CI, 4.17-9.36) conveying the highest risk. We saw similar patterns of disparities when analyzing just those children with an MBH diagnosis. CONCLUSION: Racial disparities in VE reporting highlight the need for applying an equity lens as institutions evaluate and improve reporting practices.