High prevalence of criminal legal involvement among non-fatally injured ED patients – an exploratory retrospective observational cohort analysis

Individuals who have been incarcerated are at high risk of death by homicide after release from carceral settings. Our study aimed to assess the prevalence of criminal legal system involvement (CLSI) among non-fatal violently injured patients enrolled in a hospital-based violence intervention (HVIP) program and describe demographic and clinical characteristics specific to this population. This is an exploratory retrospective cohort study of all patients enrolled in the St. Louis, Missouri based HVIP, Life Outside of Violence (LOV), between 08/15/2018 and 12/31/2024. LOV enrolls patients aged 8–30 who receive violent injury care at a partner hospital. We collected data on patient demographics, substance use, self-reported CLSI, source of medical care, and other clinical and social variables. We compared characteristics between participants with and without CLSI status using two proportions Z-tests and basic bootstrapping. During the study period 67 of 206 participants (33%) reported CLSI. Individuals with CLSI were more likely to be men (difference 37.7%; 95%CI 25.2%, 50.2%), uninsured (difference 28.9%; 95%CI 14.7%, 43.0%), and to use the emergency department (ED) or urgent care as their primary source of care (difference 18.6%; 95%CI 4.2%, 33.0%). These data show evidence for the intersectionality of CLSI and experiencing violent injury among ED patients. These data suggest the need for injury prevention efforts among this population, and potentially targeted case management for this population after injury.