O2177: Typology of Legal Intervention Trauma Among Pediatric and Young Adult Decedents: A Latent Class Analysis

Background: Legal intervention trauma (LIT) refers to injuries sustained during encounters with law enforcement (LE) and is a public health concern. LIT remains underexamined in the pediatric population. We seek to better understand the circumstances surrounding LIT-related deaths in children and young adults. Using latent class analysis (LCA), we aimed to classify cases into distinct typologies and evaluate possible disparities in key variables including age, race, mental health, incident characteristics, and police use of force.

Methods: The National Violent Death Reporting System (NVDRS) is a U.S. Centers for Disease Control and Prevention database that collects information about violent deaths from 50 U.S. states, the District of Columbia, and Puerto Rico. Focusing on decedents aged ≤26 years, we analyzed LIT cases from the NVDRS (2003-2022). Two independent reviewers extracted 13 LIT-specific data elements from coroner/medical examiner (CME) and LE narratives; a third reviewer resolved any discrepancies. We applied LCA to categorize incidents into typologies based on incident characteristics, decedent behavior, and the actions of LE. Model selection was guided by Bayesian Information Criterion (BIC), and the four-class model was selected as it had the lowest BIC (20349), indicating optimal model fit.

Results: Among 1528 decedents, we identified four distinct typologies. Class 1 accounted for 6.87% of incidents and were characterized by high rates of mental health crises (31.7%) and substance use (56.2%) with a lower likelihood of violent resistance by the decedent; 7.6% of decedents assaulted an officer and 5.7% made verbal or physical threats toward law enforcement. Black decedents accounted for 55.8% of this class. Class 2 comprised 14.2% of incidents and were largely characterized by domestic disturbances (67.2%) with decedents frequently unarmed (84.7%). Class 3 represented 54.9% of incidents and had the highest likelihood of weapon use (96.3%) and direct aggression by the decedent toward LE. Class 4, which accounted for 20.0% of incidents, were characterized by nonviolent individuals, 10.7% carrying a weapon and 12.3% posing no threat to law enforcement. Black decedents accounted for 44.0% of this class. This class had the highest proportion of encounters arising from routine traffic stops (27.6%) and the greatest use of non-lethal force prior to the application of lethal force (33.5%). Hispanic decedents were overrepresented in traffic-related encounters, comprising 21.4% of Class 4 cases compared to 19.6% overall.

Conclusion: This study identifies four distinct typologies among child and young adult decedents of LIT. Racial disparities were noted across typology classes and Black youths were disproportionately represented in low-threat scenarios that escalated to lethality. These findings indicate a need for reform, which may include improved de-escalation training, alternative response strategies for youth experiencing mental health crises, and implicit bias education.