The Knockout Game Is No Myth

February 10, 2014

I recently co-authored a letter that was published in the Lancet with my colleague, Joel Fein, MD, who directs the Violence Intervention Program in the Emergency Department at CHOP, to help raise awareness of a dangerous trend. Known as the "knockout game," as well as other names like “happy slapping” and “bombing,” this unprovoked, recreational assault usually involves a single blow to the head or neck and can often result in traumatic brain injury or death of innocent bystanders [1]. Unlike many other assaults, those from the "knockout game” do not occur as part of a theft, burglary, or drug deal, but instead, as a public random act of violence designed to result in the victim’s unconsciousness. Unfortunately, teenage boys most often play the game.

Although it’s difficult to identify the overall incidence of the game due to medical literature not describing it by name and because not all assailants confess to the intentions of their assaults, it’s growing in popularity, according to media reports [2]. We urgently need to understand and address the assailants’ motives and other precursors for such unprovoked violence. Solutions will “take a village” and a multidisciplinary, trauma-informed approach that includes community groups, parents, schools, and healthcare professionals.

Under the direction of Steven Altschuler, MD, CEO of The Children’s Hospital of Philadelphia (CHOP), CIRP@CHOP has been working hard to create the infrastructure to support bold initiatives at CHOP that will help ameliorate youth violence in Philadelphia and beyond. Underway is a comprehensive public health approach to this complex issue that addresses multiple aspects of violence: bullying, domestic violence, and physical assault. To be called the Violence Prevention Initiative (VPI), our goal is to promote a safe environment for our patients and families, one that we hope will be replicated across the country. Look for future blog posts about this new initiative soon.

1. Davis GG, Glass JM. Case report of sudden death after a blow to the back of the neck. Am J Forensic Med Pathol. 2001; 22: 13-8.
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2. Buckley, C. Police unsure if random attacks are rising threat or urban myth. New York Times. 2013-11-22. http://www.nytimes.com/2013/11/23/nyregion/knockout-game-a-spreading-menace-or-a-myth.html.