Presenter Profile
Michael Levas, MD, MS
Medical College of Wisconsin
mnlevas@mcw.edu
Dr. Michael N. Levas is a Professor of Pediatrics in the Section of Emergency Medicine at the Medical College of Wisconsin, where he serves as Vice Chair of Respect and Belonging and Medical Director of Project Ujima, a hospital-based violence intervention program. He is nationally recognized for his leadership in pediatric injury prevention, health equity, and trauma-informed care. As Principal Investigator on multiple federally funded studies—including an NIMH R01 examining long-term PTSD risk in violently injured youth using machine learning and neuroimaging—Dr. Levas has built a robust research portfolio focused on youth violence, emergency department-based interventions, and system-level approaches to trauma response. He has authored over 50 peer-reviewed publications, including more than 20 specifically addressing advocacy, injury, and violence prevention. Dr. Levas also serves as Associate Director of the Comprehensive Injury Center and holds national leadership roles with the Injury Free Coalition for Kids and the Health Alliance for Violence Intervention, advancing multidisciplinary approaches to violence prevention and community health.
Presentations
Motor Vehicle Crash Emergency Department Visits as a Marker of Future Firearm Injury Risk Among Adolescents and Young Adults
Michael Levas, MD, MS
Maria Beyer, BA, MPH
Kersten Bartelt, BSN, RN
Joe Deckert, MS, PhD
Eric Barkley
Dave Little, MD, MS
Motor vehicle crashes (MVCs) and firearm injuries are leading causes of injury-related morbidity among adolescents and young adults in the United States. Patterns of traumatic injury, risk-taking behaviors, and exposure to violence often cluster during adolescence and early adulthood; however, little is known about whether an emergency department (ED) presentation for one traumatic exposure may identify patients at increased risk for subsequent firearm injury. We sought to determine whether an ED visit for an MVC is associated with elevated risk of future firearm injury.
We conducted a retrospective matched cohort study using Cosmos, a multi-institutional Epic database representing over 300 million patient records from more than 1,800 hospitals and 41,000 clinics. Patients with an ED visit for an MVC between 2017 and 2025 and no documented prior firearm injury, MVC, or fall history were identified. MVC patients (>2 million) were matched 1:1 with patients presenting for falls (>2 million) based on age, sex, race/ethnicity, census region, and encounter month. Models additionally adjusted for rurality, social vulnerability index, ED acuity, smoking history, healthcare utilization, and comorbidities including mental health conditions, traumatic brain injury, developmental disorders, and lead exposure. Analyses were stratified by age, sex, and census region.
Among male patients, ED visits for MVCs were associated with increased subsequent firearm injury risk, particularly among adolescents and young adults. Male patients aged 10–15 years demonstrated the largest effect, with up to a three-fold increase in firearm injury risk following an MVA compared with matched fall patients across several census regions. Among males aged 16–25 years, elevated risk persisted but with smaller effect sizes, with up to an 81% increase depending on region. Associations were not consistently observed among females, and adults older than 25 years generally showed no meaningful increase in firearm injury risk. Negative-control outcomes including type 1 diabetes, eczema, and Crohn disease demonstrated no significant associations.
An ED visit for an MVC may identify adolescent and young adult males at elevated risk for future firearm injury. These findings suggest acute traumatic encounters may represent an opportunity for targeted injury prevention efforts, risk screening, and early linkage to community or hospital-based violence intervention resources. Future work should evaluate mechanisms underlying this association and determine whether ED-based interventions can reduce downstream firearm injury risk.
1. Motor Vehicle Crashes across the US may be markers for future firearm injury risk in young adolescent males.
2. Opportunities to screen for interconnected injury patterns may allow for earlier prevention and youth development efforts.
3. Large Electronic Medical Records offer a unique opportunity for injury prevention surveillance and raising the data infrastructure