Upper extremity injuries in the victims of intimate partner violence

Age-specific Patterns of Intimate Partner Violence Related Injuries in US Emergency Departments

PURPOSE

To identify intimate partner violence (IPV)-related injury patterns of U.S. patients of three age groups: <18 years (adolescents), 18-25 years (emerging adults), and >25 years (adults).

METHODS

We performed a nationally representative retrospective review of all patients presenting to U.S. Emergency Department for IPV-related injuries from 2005 through 2020. Demographics and injury patterns were calculated using statistical methods accounting for the weighted stratified data. Main outcomes were injury morphology, mechanism, severity, location, and temporal associations of IPV-related injuries among the three age groups.

RESULTS

There was a higher proportion of female victims, sexual assault cases, and lower trunk injuries among adolescents compared to emerging adults and adults. There was increasing injury severity, fractures, and hospital admissions with increasing age. Adolescents experienced a greater prevalence of fractures of the head, neck, hands, fingers, and distal lower extremity, while trunk fractures increased with age. The peak prevalence of violence-related Emergency Department visits among adolescents was in June and September, with the peak day as Tuesday.

DISCUSSION

Injurious forms of IPV are prevalent across all age groups, with sexual assault cases demonstrably higher among adolescents and increasing severity of injuries as victims age. Identification of age-specific injury patterns will aid health-care professionals and policymakers in developing targeted interventions for adolescents who experience IPV.

Global Prevalence and Mental Health Outcomes of Intimate Partner Violence Among Women: A Systematic Review and Meta-Analysis

The aim of this systematic review was to assess the magnitude of the association between types of intimate partner violence (IPV) and mental health outcomes and shed light on the large variation in IPV prevalence rates between low- to middle-income countries and high-income countries. The study is a systematic review and meta-analysis. The following databases were searched for this study: Cochrane, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Applied Social Sciences Index and Abstracts. The inclusion criteria for this study are as follows: quantitative studies published from 2012 to 2020 on IPV exposure in women aged 16+, using validated measures. Random effects meta-analyses and subgroup analysis exploring heterogeneity across population groups in different economic contexts are used in this study. In all, 201 studies were included with 250,599 women, primarily from high-income countries. Higher prevalence rates were reported for women's lifetime IPV than past year IPV. Lifetime psychological violence was the most prevalent form of IPV. Women in the community reported the highest prevalence for physical, psychological, and sexual violence in the past year compared to clinical groups. Perinatal women were most likely to have experienced lifetime physical IPV. Prevalence rates differed significantly (p = .037 to <.001) for "any IPV" and all subtypes by income country level. Meta-analysis suggested increased odds for all mental health outcomes associated with IPV including depression (odds ratio [OR] = 2.04-3.14), posttraumatic stress disorder (PTSD) (OR = 2.15-2.66), and suicidality (OR = 2.17-5.52). Clinical and community populations were exposed to high prevalence of IPV and increased likelihood of depression, PTSD, and suicidality. Future research should seek to understand women's perspectives on service/support responses to IPV to address their mental health needs. Work with IPV survivors should be carried out to develop bespoke services to reduce IPV in groups most at risk such as pregnant and/or help-seeking women.

Clinical application of upper limb fracture fixator in emergency treatment of upper limb fracture

Objective

To compare and analyze the curative effect of fracture upper limb fixator and traditional splint in emergency treatment of upper limb fracture.

Methods

This is a prospective study. A total of 80 patients with upper limb fractures admitted to the Emergency Department of Sichuan Province Orthopedic Hospital from December 2021 to August 2022 were prospectively selected as subjects. They were divided into two groups according to the random number table method: Patients in the control group were treated with traditional splint, while those in the observation group were treated with medical adjustable upper limb fixator. The clinical efficacy, treatment time, pain, fitness, probability of secondary injury and complications were compared between the two groups.

Results

After treatment, the excellent and good rate in the observation group (75.00%) was higher than that in the control group(52.50%). There was no statistically significant difference in the treatment time between the two groups. There was no significant difference in the probability of secondary injury between the two group. Statistically significant difference was observed in the comparison of pain conditions between the two groups. The total fitness rate of the observation group (97.50%) was higher than that of the control group (75.00%). The total incidence of complications in the observation group (2.50%) was lower than that in the control group (20.00%), with a statistically significant difference.

Conclusion

Fracture upper limb fixator shows various benefits in first aid of upper limb fractures, such as improving the clinical efficacy of patients with upper limb fractures, ameliorating pain, improving fitness effect, and reducing the probability of complications.

Cognitive-Affective Risk Factors of Female Intimate Partner Violence Victimization: The Role of Early Maladaptive Schemas and Strategic Emotional Intelligence

(1) Background: Intimate partner violence (IPV) is a pervasive and destructive phenomenon. There is a need for an integrated and comprehensive approach to IPV in order to align prevention, support and treatment. Still little is known about the cognitive and affective markers of IPV that are modifiable. Such knowledge, therefore, can support the effectiveness of prevention and intervention programs. In this study, we put forward a hypothesis that, after accounting for the influence of sociodemographic variables, the domains of early maladaptive schemas (EMS) and strategic emotional intelligence would provide additional information for predicting female IPV victimization. (2) Methods: 48 female survivors of IPV and 48 age-matched women with no prior experience of IPV completed the Young Schema Questionnaire-Short Form 3 (YSQ-SF3) and The Emotional Understanding Test (TRE). (3) Results: The domains of disconnection and rejection and impaired limits were significant predictors of IPV victimization, but the results did not support the predictive value for impaired autonomy, other-directedness and strategic emotional intelligence. (4) Conclusions: Our findings add to the emerging evidence of a link between disconnection and rejection domain and IPV victimization. As a consequence, maladaptive beliefs that interpersonal relationships are unstable and insecure and expose to the risk of humiliation and harm, and that basic emotional needs cannot be satisfied in close relationships, are associated with a higher risk of intimate partner violence. In this context, schema therapy appears to be a promising support for IPV victims.

Imaging of Intimate Partner Violence, From the AJR Special Series on Emergency Radiology

Intimate partner violence (IPV) is a highly prevalent public health issue with multiple adverse health effects. Radiologists are well suited to assessing a patient's likelihood of IPV. Recognition of common IPV injury mechanisms and resulting target and defensive injury patterns on imaging and understanding of differences between patients who have experienced IPV and those who have not with respect to use of imaging will aid radiologists in accurate IPV diagnosis. Target injuries often involve the face and neck as a result of blunt trauma or strangulation; defensive injuries often involve an extremity. Awareness of differences in injury patterns resulting from IPV-related and accidental trauma can aid radiologists in detecting a mismatch between the provided clinical history and imaging findings to support suspicion of IPV. Radiologists should consider all available current and prior imaging in assessing the likelihood of IPV; this process may be aided by machine learning methods. Even if correctly suspecting IPV on the basis of imaging, radiologists face challenges in acting on that suspicion, including appropriately documenting the findings, without compromising the patient's confidentiality and safety. However, through a multidisciplinary approach with appropriate support mechanisms, radiologists may serve as effective frontline physicians for raising suspicion of IPV.

Intimate Partner Violence in the Orthopaedic Patient Population: What Surgeons Need to Know

»

Intimate partner violence (IPV) is under-reported and pervasive in the orthopaedic surgical setting.

»

Screening programs that could increase reporting and assist in treatment and prevention are commonly underutilized.

»

There is little formalized education during orthopaedic surgery training for IPV.

»

The incidence of IPV continues to increase in the setting of recent stressors, such as COVID-19, and the orthopaedic surgeon should play a role in the screening and identification of patients presenting with IPV injuries and provide resources and referral.

Imaging and Non-imaging Findings of Intimate Partner Violence on the Trauma Service: A Retrospective Analysis of Two Level 1 Trauma Centers

RATIONALE AND OBJECTIVES

Intimate partner violence (IPV) is a serious public health issue. This study aims to characterize IPV-related injuries in trauma patients presenting to emergency departments (ED) who required hospitalization.

MATERIALS AND METHODS

Trauma registries of two Level 1 trauma centers were searched for assault-related ED visits by adults reporting "abuse" over 3 and 5 years to identify IPV victims. Imaging and electronic medical records were reviewed for demographics, injury type, hospital stay, and previous or subsequent presentations for presumed IPV.

RESULTS

Twenty-nine of 18,465 (0.2%) individuals seen on the trauma service had reported IPV. Majority were women (90%, mean age 37) and Caucasian (69%), over 50% had psychiatric or substance use comorbidities, and 45% reported prior IPV. Blunt trauma (22/29) was more common than penetrating trauma. Soft tissue injuries dominated when including both radiologic and non-radiologic findings. Excluding two patients who were not imaged, most frequent injuries identified on imaging were to the head/face (14/27), followed by the chest (9/27; mainly rib fractures), upper extremity and abdomen (7/27 each). All spinal fractures involved the upper lumbar spine. Synchronous injuries to multiple body regions were common, particularly craniofacial and upper extremity. Twenty-eight of 29 patients scored a grade 3-4 on the IPV severity grading scale. Eight (28%) patients required intensive care unit -level care. One patient passed. Four (14%) patients had prior IPV-related ED presentations.

CONCLUSION

While craniofacial and soft tissue injuries dominate, IPV can also result in serious thoracoabdominal, extremity and spinal injuries, even death. Multisystem injuries are common with synchronous craniofacial and upper extremity injuries being the most common combination.

Women's intimate partner violence versus community violence: Comparing injuries as presented in Iceland's largest emergency department

BACKGROUND

Intimate partner violence (IPV) is a widespread, often unidentified and hidden public health problem, which has serious consequences. The purpose of this study was to describe and compare the clinical characteristics of women's violence inflicted physical injuries, as presented at Iceland's largest Emergency Department (ED). Three groups were created based on registered reason of injury: (1) IPV, (2) community violence (CV) with a history of IPV (HIPV), and (3) CV with no history of IPV.

METHODS

Data was collected retrospectively by using the Nomesco classification system of external causes of injuries. Participants were adult women, residing in the capital area, visiting the ED during 2005-2019.

RESULTS

IPV inflicted ED visits declined by 45% during the research period and CV visits declined by 61%. Women in the IPV group had the highest prevalence of repeated new ED visits per 1000 women in the capital area. The majority of IPV occurred in residential areas (86.4%), inflicted by a current partner (54.7%), and included only one perpetrator (95.3%). Women involved in CV were most likely to visit the ED on weekends (p = 0.003) and IPV women were most likely to visit between 08:00 and 16:00 (p < 0.001). Superficial injuries were the most common type of injury among all groups and IPV women were twice as likely (7.1%) to have injuries on their neck than CV women (3.5%). IPV women were most likely to be admitted (3.0%).

CONCLUSION

Time of ED visit, number of perpetrators and location of assault can be indicators of IPV inflicted injuries, as opposed to otherwise inflicted injuries. Repeated visits, superficial injuries and neck injuries might also be an indicator of IPV, however wounds and sprains and injuries on head and upper limbs are more likely to be non-IPV inflicted.

Facial injury patterns in victims of intimate partner violence

Purpose

To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV).

Methods

A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution’s violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns.

Results

The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19–76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients.

Conclusion

/advances in knowledge.

The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.

Injury patterns and associated demographics of intimate partner violence in men presenting to U.S. emergency departments

Research suggests that there are differences between sexes in physical intimate partner violence (IPV) victimization that could lead to different injury patterns. In addition, research shows that men under-report their injuries yet may suffer grave consequences. It is, thus, vital to establish physical injury patterns in male IPV victims. A retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System-All Injury Program data from 2005 to 2015 for all IPV-related injuries in both male and female patients. Sex differences by demographics, mechanism, anatomic location, and diagnoses of IPV injuries were analyzed using statistical methods accounting for the weighted stratified nature of the data. IPV accounted for 0.61% of all emergency department visits; 17.2% were in males and 82.8% in females. Male patients were older (36.1% vs. 16.8% over 60 years), more likely to be Black (40.5% vs. 28.8%), sustained more injuries due to cutting (28.1% vs. 3.5%), more lacerations (46.9% vs. 13.0%), more injuries to the upper extremity (25.8% vs. 14.1%), and fewer contusions/abrasions (30.1% vs. 49.0%), compared to female IPV patients (p < .0001). There were also more hospitalizations in men (7.9% vs. 3.7% p = .0002). Knowledge of specific IPV-related injury characteristics in men will enable healthcare providers to counteract underreporting of IPV.

Upper extremity fractures due to intimate partner violence versus accidental causes

Purpose

The purpose of this study is to evaluate the prevalence of intimate partner violence (IPV)-related upper extremity fractures (UEF) in women presenting to US emergency departments (ED) and compare their anatomic location to those due to accidental falls or strikes.

Methods

An Institutional Review Board exempt, retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System’s All Injury Program data from 2005 through 2015 for all UEF sustained in women 15 to 54 years old. Injuries based on reported IPV versus accidental falls or strikes were analyzed accounting for the weighted, stratified nature of the data.

Results

IPV-related UEF represented 1.7% of all UEF and 27.2% of all IPV fractures. The finger was the most common fracture site in IPV (34.3%) and accidental striking (53.3%) but accounted for only 10% of fall-related UEF. There was a higher proportion of shoulder fractures in IPV (9.2%) compared to accidental falls (7.4%) or strikes (2.9%). The odds of a finger fracture were 4.32 times greater in IPV than falling and of a shoulder fracture were 3.65 greater in IPV than accidental striking (p < 0.0001).

Conclusions

While the finger is the most common site for IPV UEF, it is also the most common location for accidental striking. A lower proportion of finger fractures in fall and of shoulder/forearm fractures in accidental striking should prompt the radiologist to discuss the possibility of IPV with the ED physician in any woman presenting with a finger fracture due to fall and a shoulder/forearm fracture with a vague history of accidental striking.

Imaging patterns of lower extremity injuries in victims of intimate partner violence (IPV)

PURPOSE

To describe the pattern and distribution of lower extremity injuries in victims of intimate partner violence (IPV).

MATERIALS AND METHODS

A retrospective radiological review of 688 patients reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 88 patients with 154 lower extremity injuries. All lower extremity injuries visible on radiological studies were analyzed. Concomitant, recurrent, and associated injuries were also collected, in addition to the demographic data.

RESULTS

The injuries consisted of 103 fractures, 46 soft tissue injuries, and 5 dislocations. The foot was the most common site of injury representing 39% (60/154) of total injuries, 48% (49/103) of fractures, 17% (8/46) of soft tissue injuries, and 3 dislocations. The ankle was the second most common site of injury representing 30% (47/154) of total injuries, 20% (21/103) of fractures, and 57% (26/46) of soft tissue injuries. Recurrent injuries of the lower extremity were seen in 30% (26/88) of victims who had 74 recurrent injuries. The most common sites of recurrent injury were the foot and ankle, representing 72% (53/74) of recurrent injuries.

CONCLUSION

Recurrent injuries of the foot and ankle, synchronous craniofacial injuries, and upper extremity injuries in young women (<35 years) should prompt radiologists to consider IPV.