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To characterize the circumstances of youth intentional violence in emergency department patients and compare circumstances of events between gender and age groups.Cross-sectional survey and chart review of a 9-month consecutive sample of 8-year to 24-year-old intentionally injured patients (excluding child abuse or domestic violence) in 3 emergency departments.Four hundred twenty-six patients were included in the study. Most events were fights and most occurred in the street. Fists, hands, and feet were the most common weapon, and contusions or abrasions the most common injury. Most events involved only 2 people, and most incidents involved friends or acquaintances. Events involving 8 to 14 year olds were more likely to occur in school, to involve only fists, hands, or feet, and involve a friend. Eight to 14 year olds were less likely to use a firearm. Among the younger group, females were more likely than males to be injured in an assault, sustain a contusion or abrasion, and be involved in an incident with multiple participants. Older females were more likely than males to be involved in an event in the home, and sustain a contusion, abrasion, or bite.This study characterizes the circumstances of youth intentional violence that result in emergency department visits for injuries. Although similarities exist between different age groups and genders, some key differences between the groups are illustrated. Understanding the differences between violent events in different age groups and genders may help clinicians recognize injury patterns and possibly guide alternative interventions.