Youths who die in violent encounters with law enforcement are disproportionately Black, according to a national study led by a team of CHOC surgeons and researchers.

“Racial Disparity Among Youth Decedents of Legal Intervention Trauma,” published online in the Journal of American College of Surgeons in October 2023 and in print in February 2024, came to that conclusion after identifying 1,281 youth decedents from 2013 to 2018 in the Centers for Disease Control’s National Violent Death Reporting System (NVDRS).

“The goal of the study was to let the data speak for itself,” said lead author Dr. Peter Yu, a pediatric general and thoracic surgeon and chair of CHOC’s department of surgery. “It’s really important that this very sensitive national conversation be grounded in data.”

One key finding: Black youths were significantly more likely to experience force reported as justified by law enforcement than White youths (80.9% vs. 82.4%)Additionally, Black youth were not more likely than White youth to be involved in a violent crime at the time of their fatal encounters with police.

Dr. Yu said the study is one of the first to examine legal intervention trauma (LIT), defined as any injury sustained as a result of an encounter with a law enforcement official, in the pediatric population. The study builds on a related CHOC-led report published in 2022 that used information from the National Trauma Data Bank (NTDB).

Provoking questions

Dr. Yu said the LIT study is an apolitical examination of a highly charged issue that examined the associations between demographics, violent status, and law enforcement tactics in encounters with youth that ended in their deaths. Of the 1,281 youth decedents identified, all were over 12 years old and aged 26 or younger.

Decedents were classified as “violent” if they possessed a weapon, were committing a violent crime, or if law enforcement reported justified use of force.

Among a subset of 85 cases in which law enforcement reported justified use of force despite the decedent not possessing a weapon or committing a violent crime, the precipitating event was more often a traffic stop for Black youths than for White youths (28.5% vs. 6.7%).

“These findings indicate a racial disparity among youth decedents of LIT,” the report said. “They provoke the following question: What are the criteria being used to justify force in these cases, and are those criteria being applied equitably?”

CHOC colleagues working with Dr. Yu on the LIT study were pediatric surgeon Dr. Laura Goodman; research fellow Dr. Annie Giron; pediatric surgeon Dr. Yigit Guner, and John Schomberg, Ph.D., a biostatistician in the department of nursing. The other contributing authors were Dr. John Riley, a general surgery resident at Children’s Hospital of Philadelphia (CHOP), and Dr. William Peranteau, a pediatric surgeon at CHOP.

Gender, drugs, and mental state

The research team’s 2022 analysis of the NTDB showed that children who experienced any type of injury secondary to LIT were more likely to be older, male, and Black, Latino or Native American. Taller, heavier Black children were more likely to sustain LIT-related firearm trauma. A similar effect was not seen among White children.

The NVDRS data used in the 2023 study captured over 600 unique data elements, including decedent characteristics, weapons used, toxicology reports, and mental health issues. In addition, the data includes narrative reports of law enforcement personnel, coroners, and medical examiners.

Of the 1,281 decedents identified between 2008 and 2013, males accounted for 96% of the fatalities. White youths accounted for 48.1% of the study population and Black youths 45.1%. This is notable because the Black population in the U.S. represents only 14 to 15% of the U.S. population.

Fifteen percent of the study population tested positive for an illicit substance. Black youths were less likely to be under the influence of alcohol and/or illegal drugs than the overall study population (81.7% vs. 86.2%). Most of the study population (89.6%) did not carry a mental health diagnosis.

There was no significant difference in mental health status when stratified by race, ethnicity, or age. The cause of death in most LIT decedents was firearm (94.3%). Motor vehicle-related death was the next most common cause of death (3%), with 41% of these involving use of a police pursuit intervention technique (a tactic by which a pursuing car forces a fleeing car to turn sideways abruptly and then stop).

Sound footing

Dr. Yu said he hopes the study will spark further discussions about racial disparities in fatal encounters between youth and law enforcement.

“Working at a children’s hospital,” said Dr. Yu, “it’s our responsibility to use data in an apolitical fashion.

“In medicine, when we make a decision about a type of surgery or type of medication to use or a clinical decision, we want that to be based on data,” he added. “The data will drive the best outcomes. And so it’s my hope that this paper will provide data that will result in an improved outcome for these tragic events.”

To save lives, the report said, standardized criteria for the suitable application of lethal force should be established, and cases of LIT resulting in death should be collected and reviewed by an independent body to ensure these criteria are being applied equitably.

“Surgeons occupy a unique position in society,” the report said. “We care for the injured. We care for children. We work with law enforcement on a regular basis in the trauma bay. We are apolitical in how we treat our patients and their families. We are guided by data, not anecdotes. We are leaders in our communities. And we support efforts to reduce gun violence as a public health emergency.

“It is our hope that distribution of these objective data…will provide surgeons across the country with sound footing from which to advocate in their local community and at the highest levels of government for improved safety for citizens of all races, ethnicities and backgrounds.”