Injury pattern and outcome of assault victims: An emergency department perspective


Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India


Background: Violence-related injuries top the list as a cause of mortality in the 15–40 years' age group in India. In contrast to the West, the spectrum of assault injuries in Southeast Asian countries is different. Our main aim was to profile intentional injuries due to interpersonal violence treated in the emergency department (ED) and to describe the severity, pattern, etiology, and outcome in such patients. Materials and Methods: We conducted a case-series analysis of assault victims who presented to the ED of Christian Medical College and Hospital, Vellore, India, from January 2017 to December 2018. Data were retrieved electronically from the clinical workstation. Categorized variables were summarized using counts and percentages. Quantitative variables were summarized using mean and standard deviation (SD). Results: During the study period, a total of 381 patients with a mean age of 36.16 (SD: 13.9) years presented to the ED. Male (81.9%) predominance was noted among these victims. A majority of them, i.e., 257 (67%) victims, were assaulted by people that were known to them, of which 66 (17.3%) victims were reported as domestic violence. Blunt objects were used in most, i.e., 234 (61.4%) cases. A spike in the incidence of assault, in general, was noted in the month of September during the South Indian festival season. Approximately one-fourth (21.3%) of the victims required hospital admission. Overall, 15.74% of the victims had to undergo major surgical procedures. There were no mortalities recorded among these study participants. Conclusions: Violence and its consequences lead to severe injuries and levy a heavy burden on health care. There is an urgent need to address the social and emotional needs of adolescents and young adults who are most at risk of being the victims of assault.


1. Rutherford A, Zwi AB, Grove NJ, Butchart A. Violence: A glossary. J Epidemiol Community Health 2007;61:676‑80.
2. Kruse M, Sørensen J, Brønnum‑Hansen H, Helweg‑Larsen K. Identifying victims of violence using register‑based data. Scand J Public Health 2010;38:611‑7.
3. Baruah A, Baruha A. Epidemiological study of violence: A study from North East India. Indian J Community Med 2007;32:137.
4. Mercy JA, Hillis SD, Butchart A, Bellis MA, Ward CL, Fang X, et al. Interpersonal Violence: Global Impact and Paths to Prevention. In: Mock CN, Nugent R, Kobusingye O, Smith KR, editors. Injury Prevention and Environmental Health [Internet]. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017. Available from: [Last cited on 2020 Mar 04].
5. Sivarajasingam V, Shepherd JP. Trends in community violence in England and Wales 1995‑1998: An accident and emergency department perspective. Emerg Med J 2001;18:105‑9.
6. Steen K, Hunskaar S. Violence in an urban community from the perspective of an accident and emergency department: A two‑year prospective study. Med Sci Monit 2004;10:CR75‑9.
7. Corso PS, Mercy JA, Simon TR, Finkelstein EA, Miller TR. Medical costs and productivity losses due to interpersonal and self‑directed violence in the United States. Am J Prev Med 2007;32:474‑82.
8. Gal M, Rus D, Peek‑Asa C, Cherecheş RM, Sirlincan EO, Boeriu C, et al. Epidemiology of assault and self‑harm injuries treated in a large Romanian Emergency Department. Eur J Emerg Med 2012;19:146‑52.
9. Mahapatro M, Gupta R, Gupta V. The risk factor of domestic violence in India. Indian J Community Med 2012;37:153‑7.
10. Gun violence: Prediction, Prevention, and Policy. Available from:; [Last accessed on 2020 Jun 04].
11. Swarnkar M, Pal G, Lilhare S. Assault and self‑harm injuries: Pattern, severity and etiology of injuries in victims attending emergency department of teaching hospital in central India. Int Surg J 2016;3:1618‑22.
12. Thube HR, Chikhalkar BG, Nanandkar SD. Aprospective study of injury pattern in victim of assault attended in South Mumbai Government Hospital. J Indian Acad Forensic Med 2015;37:37.
13. Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national disability‑adjusted life‑years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1859‑922.
14. Lee WK, Lim D, Park H. Disability‑adjusted life years (DALYs) for injuries using death certificates and hospital discharge survey by the Korean Burden of disease study 2012. J Korean Med Sci 2016;31 Suppl 2:S200‑7.
15. Available from: [Last accessed on 2020 Jul 30].
16. Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997;43:922‑5.
17. Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: Incidence, mortality, disability‑adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev 2016;22:3‑18.
18. Khan I, Shakeel M, Usmani JA, Hasan SA. Emerging trends of intentional firearm injuries in northern India: A Study. J Clin Diagn Res 2016;10:HC01‑4.
19. Abhilash KP, Chakraborthy N, Pandian GR, Dhanawade VS, Bhanu TK, Priya K. Profile of trauma patients in the emergency department of a tertiary care hospital in South India. J Family Med Prim Care 2016;5:558‑63.
20. Sousa CA. Political violence, collective functioning and health: a review of the literature. Med Confl Surviv 2013;29:169-97.
21. Hill S, Marshall TC. Beliefs about sexual assault in India and Britain are explained by attitudes toward women and hostile sexism. Sex Roles 2018;79:421‑30.
22. Sahu G, Mohanty S, Dash JK. Vulnerable victims of sexual assault. Med Sci Law 2005;45:256‑60.
23. Aggression Involving Alcohol: Relationship to Drinking Patterns and Social Context‑Wells‑2003‑Addiction‑Wiley Online Library. Available from:‑0443.200
3.00253.x?sid=nlm%3Apubmed. [Last accessed on 2020 Jun 04].
24. Norström T, Pape H. Alcohol, suppressed anger and violence. Addiction 2010;105:1580‑6.
25. Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. Firearm injuries in the United States. Prev Med 2015;79:5‑14.