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Bullying: An Unexamined Cause of Assault-related Emergency Department Visits for Urban Adolescents



This study aims to understand the prevalence of bullying in as well as the attributes and characteristics of injuries resulting from bullying treated in the emergency department (ED).


Data come from 188 adolescents (ages 10–15) who were treated for a peer-related assault-injury in two United States urban EDs. Descriptive statistics were used to understand differences between bullied and non-bullied adolescents. A receiver operating curve (ROC) analysis was used to evaluate a possible risk index.


Forty percent of adolescents identified that the incident was a result of bullying. Bullied youth reported significantly more previous bullying victimization and post-traumatic stress symptoms, but less aggression and rule breaking. A group fight, the fight involving a discordant gender, perceiving oneself as a victim, feeling that the person(s) meant to hurt them, and reporting that the fight was not resolved were significantly associated with an injury as the result of bullying. Situational characteristics such as the fight occurring in school and not arriving to the ED in an ambulance also were associated with an increased likelihood of a bullying situation. Having greater than three of these risk factors correctly identified 88% of youth who attributed the situation to bullying.


Taking into account the characteristics of the assault and asking about the adolescent’s attributions of the incident can help identify patients and facilitate tailoring of appropriate intervention by social workers and other ED providers. ID: NCT01770873.

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This research was supported by the National Institute on Minority Health And Health Disparities (Grant P20MD000198). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

SLJ conceived of the study, ran analyses, and drafted the manuscript; LR, VJ, and JF facilitated data collection, TC and JF conceptualized the project and received funding; LR, VJ, JF, and TC provided feedback on drafts and approved final manuscript.

Correspondence to Sarah Lindstrom Johnson.

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All authors (names blinded for review) declare that they have no conflict of interest.

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A procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration an and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Lindstrom Johnson, S., Ryan, L.M., Jones, V. et al. Bullying: An Unexamined Cause of Assault-related Emergency Department Visits for Urban Adolescents. Child Adolesc Soc Work J (2020).

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  • Violence
  • Peer-assault
  • Screening
  • Intervention