Statement of Purpose Early identification of bullying through assessment during outpatient visits may provide opportunities to interrupt the escalation of peer-to-peer physical violence by offering preventative services. Our aims were to (1) determine the association between bullying and violence-related physical injury among youth within a pediatric healthcare network and (2) examine the prevalence of bullying among youth participating in a hospital-based violence intervention program (HVIP).

Methods/Approach Multiple retrospective data sources were linked from 2015–2019 for youth ages 8–18 years including (1) Emergency Department (ED) injury surveillance, (2) HVIP interviews, and (3) brief bullying surveys (BBS) administered during outpatient visits. We compared bullying disclosure on BBS among youth who received ED care for violence-related injury and those who did not. Next, among youth participating in an HVIP who completed BBS, we compared the proportion of who disclosed bullying in HVIP interviews versus BBS.

Results Youth receiving ED care for violence-related injury were significantly more likely to disclose bullying on BBS compared to youth with no violence-related ED visit (20.0% vs. 5.5%, p<0.001). For youth receiving HVIP services, 55% reported bullying in HVIP interviews compared to only 30% who reported bullying on BBS.

Conclusion Youth who received ED care for violence-related injury were more likely to disclose bullying as part of routine outpatient screening compared to uninjured peers. However, when comparing HVIP interviews and outpatient BBS, we observed differences in the proportion of youth disclosing bullying, suggesting refinement of clinical screening efforts is needed to better identify youth at risk for violence.

Significance Bullying screening during outpatient visits could provide opportunities to intervene prior to the escalation of peer violence. Enhancing the specificity and relevance of bullying screening may increase its validity and expand identification of youth who can benefit from early intervention.