Missed opportunities: emergency department visits by police-identified victims of intimate partner violence

Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australian data-linkage study

BACKGROUND

Family violence is a leading social determinant of mental ill-health but its link to mental health-related emergency department presentations is poorly understood. Existing research has largely used retrospective designs with a focus on victimisation, typically among women. We examined whether police-reported family violence victimisation and perpetration were prospectively associated with mental health emergency department presentations in women and men. We also identified family violence risk and vulnerability characteristics associated with such presentations.

METHODS

Demographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e., primary victims) and 1470 respondents (i.e., persons alleged to have perpetrated family violence) from family violence reports in 2016-17. Emergency mental health presentations 22-30 months post-family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations.

RESULTS

Emergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45 + . Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents, respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics.

CONCLUSIONS

Police-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term. Strengthened cross-sector collaboration is needed to identify, address, and refer individuals with overlapping family violence and mental health needs and to improve victims' and perpetrators' access to community mental health and related services. This should help prevent individuals from reaching a crisis point in their mental health.

Insights from linking police domestic abuse data and health data in South Wales, UK: a linked routine data analysis using decision tree classification

BACKGROUND

Exposure to domestic abuse can lead to long-term negative impacts on the victim's physical and psychological wellbeing. The 1998 Crime and Disorder Act requires agencies to collaborate on crime reduction strategies, including data sharing. Although data sharing is feasible for individuals, rarely are whole-agency data linked. This study aimed to examine the knowledge obtained by integrating information from police and health-care datasets through data linkage and analyse associated risk factor clusters.

METHODS

This retrospective cohort study analyses data from residents of South Wales who were victims of domestic abuse resulting in a Public Protection Notification (PPN) submission between Aug 12, 2015 and March 31, 2020. The study links these data with the victims' health records, collated within the Secure Anonymised Information Linkage databank, to examine factors associated with the outcome of an Emergency Department attendance, emergency hospital admission, or death within 12 months of the PPN submission. To assess the time to outcome for domestic abuse victims after the index PPN submission, we used Kaplan-Meier survival analysis. We used multivariable Cox regression models to identify which factors contributed the highest risk of experiencing an outcome after the index PPN submission. Finally, we created decision trees to describe specific groups of individuals who are at risk of experiencing a domestic abuse incident and subsequent outcome.

FINDINGS

After excluding individuals with multiple PPN records, duplicates, and records with a poor matching score or missing fields, the resulting clean dataset consisted of 8709 domestic abuse victims, of whom 6257 (71·8%) were female. Within a year of a domestic abuse incident, 3650 (41·9%) individuals had an outcome. Factors associated with experiencing an outcome within 12 months of the PPN included younger victim age (hazard ratio 1·183 [95% CI 1·053-1·329], p=0·0048), further PPN submissions after the initial referral (1·383 [1·295-1·476]; p<0·0001), injury at the scene (1·484 [1·368-1·609]; p<0·0001), assessed high risk (1·600 [1·444-1·773]; p<0·0001), referral to other agencies (1·518 [1·358-1·697]; p<0·0001), history of violence (1·229 [1·134-1·333]; p<0·0001), attempted strangulation (1·311 [1·148-1·497]; p<0·0001), and pregnancy (1·372 [1·142-1·648]; p=0·0007). Health-care data before the index PPN established that previous Emergency Department and hospital admissions, smoking, smoking cessation advice, obstetric codes, and prescription of antidepressants and antibiotics were associated with having a future outcome following a domestic abuse incident.

INTERPRETATION

The results indicate that vulnerable individuals are detectable in multiple datasets before and after involvement of the police. Operationalising these findings could reduce police callouts and future Emergency Department or hospital admissions, and improve outcomes for those who are vulnerable. Strategies include querying previous Emergency Department and hospital admissions, giving a high-risk assessment for a pregnant victim, and facilitating data linkage to identify vulnerable individuals.

FUNDING

National Institute for Health Research.

Intimate Partner Violence Among International and Interprovincial Migrants: A Population-Based Analysis of Canadian Linked Immigration and Justice Data

Factors associated with IPV among immigrant women are not well understood. Using linked immigration and justice data, we compared the incidence of justice-identified IPV (JIIPV) among 58,564 international immigrant women born outside of Canada, 30,098 women born in other Canadian provinces (i.e., interprovincial migrants), and 88,662 long-term Manitoban resident women. International immigrant women had the lowest incidence of JIIPV compared to matched long-term Manitobans (adjusted hazard ratio (aHR) 0.49, 95% CI: 0.43-0.56) and interprovincial migrants (aHR 0.56, 95% CI: 0.43-0.73). Among immigrants, JIIPV varied substantially according to birthplace, increased with length of residence, and was less frequent among secondary immigrants.

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.

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

Importance

Elder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment.

Objective

To examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults.

Design, Setting, and Participants

This retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022.

Main Outcomes and Measures

We used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses.

Results

This study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P < .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P < .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P < .001).

Conclusions and Relevance

In this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.

Intimate partner violence, substance use, and health comorbidities among women: A narrative review

Exposure to intimate partner violence (IPV), including physical, sexual, and psychological violence, aggression, and/or stalking, impacts overall health and can have lasting mental and physical health consequences. Substance misuse is common among individuals exposed to IPV, and IPV-exposed women (IPV-EW) are at-risk for transitioning from substance misuse to substance use disorder (SUD) and demonstrate greater SUD symptom severity; this too can have lasting mental and physical health consequences. Moreover, brain injury is highly prevalent in IPV-EW and is also associated with risk of substance misuse and SUD. Substance misuse, mental health diagnoses, and brain injury, which are highly comorbid, can increase risk of revictimization. Determining the interaction between these factors on the health outcomes and quality of life of IPV-EW remains a critical need. This narrative review uses a multidisciplinary perspective to foster further discussion and research in this area by examining how substance use patterns can cloud identification of and treatment for brain injury and IPV. We draw on past research and the knowledge of our multidisciplinary team of researchers to provide recommendations to facilitate access to resources and treatment strategies and highlight intervention strategies capable of addressing the varied and complex needs of IPV-EW.

Changes in ambulance departures for assault calls during COVID-19 pandemic restrictions

Restrictions related to COVID-19 changed the daily behavior of people, including the expression of violence. Although an increased incidence of violent behavior, especially domestic violence, was expected during the pandemic, retrospective analyses have yielded mixed results. Records of ambulance departures to address injuries caused by assaults in the Pilsen region, Czech Republic, during the restrictive measures during the national state of emergency were compared to data from 3 previous years using general linear models. The number and severity of assaults were analyzed for the whole sample and separately for patients of either sex, for residential or nonresidential locations, and for domestic violence. Controlling for the seasonal effects, the number of assaults decreased by 39% during the pandemic restrictions compared to the 3 previous years. No difference was found between the effects of restrictions on assaults resulting in an injury of a male or female patient. The decrease was specifically pronounced in the sample of assaults in nonresidential locations, while no effect of restrictions was observed in assaults in residential locations and domestic assaults. Pandemic restrictions were associated with a decreased incidence of violent assaults that required ambulance services. Although the incidence decreased especially in those assaulted outside of their homes, we found no support for an increase in domestic violence or violence against women. Pandemic restrictions may have served as a protective rather than a risk factor for assaults severe enough to warrant a call for ambulance services.

Child safety assessments during a caregiver's evaluation in emergency departments after intimate partner violence

BACKGROUND

Physical abuse of children is reported to occur in 30%-60% of homes with intimate partner violence (IPV). IPV in adult victims presenting to emergency departments (EDs) represents a critical opportunity to evaluate for child safety.

OBJECTIVES

The primary objective was to determine the frequency of child safety assessments (CSAs), defined as any documented inquiry about the presence of children in the household, when adults presented to EDs for IPV. The secondary aims were to assess (1) the impact of demographic factors, ED type, and social work (SW) involvement on the likelihood of CSAs; (2) the nature of children's exposure; and (3) the frequency of child protective services (CPS) reports.

METHODS

We performed a chart review of encounters with ICD-10-CM codes for patients aged 18-60 with IPV presenting to three EDs in Connecticut from 2017 through 2019.

RESULTS

CSAs were completed in 179/277 encounters (78.9%) and were more likely to be completed in encounters with SW involvement than without (162/171 [94.7%] vs. 17/56 [30.3%], p < 0.001). A total of 143 children lived in the home at the time of the incident; of the 107 children for whom the nature of exposure was known, 10 (9.3%) were physically involved and 26 (24.2%) were direct witnesses to the violence. CPS reports were made in 52.4% of the encounters in which children lived in the home.

CONCLUSIONS

CSAs were omitted in one-fifth of encounters for IPV. Given the high prevalence of children involved in IPV episodes, ED encounters for IPV represent an opportunity to improve the safety of children.

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.

Intimate Partner Violence During Recovery from an Orthopaedic Injury: An Exploratory, Prospective, Multicenter, Observational Cohort Study

BACKGROUND

Orthopaedic injuries may lead to an increased incidence of intimate partner violence (IPV) during recovery as people dependent on others' help are at a higher risk for abuse. Additionally, there is a lack of understanding of how IPV affects injury recovery. In women being treated for an orthopaedic injury, we aimed to determine the number of new IPV disclosures in the 12 months after an injury and to explore the impact of IPV on recovery.

METHODS

We enrolled 250 female participants from 6 orthopaedic fracture clinics in Canada, the Netherlands, Spain, and Finland. IPV disclosure and clinical outcomes were assessed at the initial visit and during the 12-month follow-up period.

RESULTS

Of 250 participants, 81 (32.4% [95% confidence interval (CI), 26.6% to 38.2%]) had a history of IPV in their lifetime and disclosed this at their initial orthopaedic clinic appointment. Twenty-one participants (12.4% [95% CI, 7.5% to 17.8%]) who did not disclose abuse at the initial visit disclosed IPV during the follow-up. In our a priori unadjusted analysis, disclosure of IPV at the initial appointment or a subsequent follow-up appointment was associated with a 32% lower likelihood of returning to a pre-injury level of function with no restrictions regarding responsibilities at home (hazard ratio, 0.68 [95% CI, 0.46 to 0.99]; p = 0.046). Participants disclosing IPV had lower health-related quality of life on the EuroQol-5 Dimensions (EQ-5D) at the 6-month-follow-up, with adjusted mean differences of -5.3 (95% CI, -10.2 to -0.4, p = 0.04) for the visual analog scale and -0.06 (95% CI, -0.11 to -0.01; p = 0.02) for the Function Index. They also had lower Function Index scores at the final 12-month follow-up visit, with an adjusted mean difference of -0.06 (95% CI, -0.10 to -0.02; p = 0.006).

CONCLUSIONS

A surprisingly high percentage of women disclosed IPV within 12 months after the injury. Our exploratory results suggest that women who disclose IPV may have lower health-related quality of life. This study supports the need to optimize orthopaedic clinics to provide appropriate support for asking about and assisting individuals who experienced IPV. Additional research is warranted to further explore these findings.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Design and Evaluation of a Curriculum on Intimate Partner Violence for Medical Students in an Emergency Medicine Clerkship

PURPOSE

Intimate partner violence (IPV) is a widespread public health issue that is relevant to all areas of medicine. Patients who suffer from IPV often contact the health care system via the emergency department, making this a particularly important but too often overlooked issue in this setting. Education on IPV varies in medical schools and emergency medicine (EM) educational programs, and evidence suggests that a barrier to assessing for IPV is a lack of adequate training of clinicians. In this study, we sought to design, implement and evaluate the efficacy of a curriculum on IPV geared towards medical students on an EM clerkship.

METHODS

We assembled a multi-disciplinary team of EM education faculty, a resident content expert on IPV, and social workers to design a two-part curriculum that was administered to medical students on an EM clerkship. The curriculum involved a 20-minute narrated slide presentation viewed asynchronously, followed by a 1-hour case-based discussion session. The curriculum was evaluated using a 13-item self-assessment survey on knowledge, comfort level and skill in managing victims of IPV, administered electronically before and after the curriculum. Survey results were compared pre- and post-curriculum using Wilcoxon signed-rank test.

RESULTS

Thirty-four students completed the curriculum and 26 completed both the pre and post self-assessment surveys. A statistically significant improvement in knowledge, comfort level and skills was observed in 11 of the 13 survey elements.

CONCLUSION

Based on the self-assessment survey results, this curriculum was well received and successfully increased participants' comfort, knowledge and skill level regarding assessment of patients for IPV. This is a focused and feasible curriculum that can be easily incorporated into an EM clerkship to provide effective education on a relevant but often overlooked topic.

Fears of disclosure and misconceptions regarding domestic violence reporting amongst patients in two US emergency departments

Patients often do not disclose domestic violence (DV) to healthcare providers in emergency departments and other healthcare settings. Barriers to disclosure may include fears and misconceptions about whether, and under what circumstances, healthcare providers report DV to law enforcement and immigration authorities. We sought to assess undocumented Latino immigrants (UDLI), Latino legal residents/citizens (LLRC) and non-Latino legal residents/citizens (NLRC) beliefs about disclosure of DV victimization to healthcare providers and healthcare provider reporting of DV to law enforcement and immigration authorities. From 10/2018-2/2020, we conducted this survey study at two urban emergency departments (EDs) in California. Participants, enrolled by convenience sampling, responded to survey questions adapted from a previously published survey instrument that was developed to assess undocumented immigrant fears of accessing ED care. Our primary outcomes were the proportions of UDLI, LLRC and NLRC who knew of someone who had experienced DV in the past year, whether these DV victims were afraid to access ED care, reasons DV victims were afraid to access ED care, and rates of misconceptions (defined according to current California law) about the consequences of disclosing DV to healthcare providers. Of 667 patients approached, 531 (80%) agreed to participate: 32% UDLI, 33% LLRC, and 35% NLRC. Of the 27.5% of respondents who knew someone who experienced DV in the past year, 46% stated that the DV victim was afraid to seek ED care; there was no significant difference in this rate between groups. The most common fears reported as barriers to disclosure were fear the doctor would report DV to police (31%) and fear that the person perpetrating DV would find out about the disclosure (30.3%). Contrary to our hypothesis, UDLI had lower rates of misconceptions about healthcare provider and law enforcement responses to DV disclosure than LLRC and NLRC. Fear of disclosing DV and misconceptions about the consequences of disclosure of DV to healthcare providers were common, indicating a need for provider, patient, and community education and changes that lower barriers to help-seeking.

Screening for intimate partner violence in healthcare settings: An implementation-oriented systematic review

Background

Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. Screening for IPV within healthcare settings can identify women who experience IPV and inform counseling, referrals, and interventions to improve their health outcomes. Unfortunately, many screening programs used to detect IPV have only been tested in research contexts featuring externally funded study staff and resources. This systematic review therefore investigated the utility of IPV screening administered by frontline clinical personnel.

Methods

We conducted a systematic literature review focusing on studies of IPV screening programs for women delivered by frontline healthcare staff. We based our data synthesis on two widely used implementation models (Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] and Proctor's dimensions of implementation effectiveness).

Results

We extracted data from 59 qualifying studies. Based on data extraction guided by the RE-AIM framework, the median reach of the IPV screening programs was high (80%), but Emergency Department (ED) settings were found to have a much lower reach (47%). The median screen positive rate was 11%, which is comparable to the screen-positive rate found in studies using externally funded research staff. Among those screening positive, a median of 32% received a referral to follow-up services. Based on data extraction guided by Proctor's dimension of appropriateness, a lack of available referral services frustrated some efforts to implement IPV screening. Among studies reporting data on maintenance or sustainability of IPV screening programs, only half concluded that IPV screening rates held steady during the maintenance phase. Other domains of the RE-AIM and Proctor frameworks (e.g., implementation fidelity and costs) were reported less frequently.

Conclusions

IPV is a population health issue, and successfully implementing IPV screening programs may be part of the solution. Our review emphasizes the importance of ongoing provider trainings, readily available referral sources, and consistent institutional support in maintaining appropriate IPV screening programs.

Plain language abstract

Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. IPV screening and response can identify women who experience IPV and can inform interventions to improve their health outcomes. Unfortunately, many of the screening programs used to detect IPV have only been tested in research contexts featuring administration by externally funded study staff. This systematic review of IPV screening programs for women is particularly novel, as previous reviews have not focused on clinical implementation. It provides a better understanding of successful ways of implementing IPV screening and response practices with frontline clinical personnel in the context of routine care. Successfully implementing IPV screening programs may help mitigate the harms resulting from IPV against women. Findings from this review can inform future efforts to improve implementation of IPV screening programs in clinical settings to ensure that the victims of IPV have access to appropriate counseling, resources, and referrals.

Intentional injury and violent death after intimate partner violence. A retrospective matched-cohort study

The incidence of intimate partner violence (IPV) varies according to IPV definitions and data collection approaches. The criminal Justice system assesses IPV through a review of the evidence gathered by the police and the court hearings. We aimed to determine the association between IPV, as identified in criminal Justice disposition records, and subsequent healthcare-identified intentional injury inflicted by others, including violent death. We conducted a retrospective population-based matched-cohort study using linked multisectoral databases. Female adult Manitoba residents identified as victims of IPV in provincial prosecution and disposition records 2004 to 2016 (n = 20,469) were matched to three non-victims (n = 61,407) of similar age, relationship status and place of residence at the date of the IPV incident. Outcomes were first healthcare use for intentional injury and violent death, assessed in Emergency Department visits, hospitalizations and Vital Statistics deaths records. Conditional Cox Regression was used to obtain Hazard Ratios (HR) with 95% confidence intervals (CI). The risk of intentional injury was 8.5 per 1000 women among non-victims of IPV and 55.8 per 1000 women among IPV victims. The Hazard Ratios associated with IPV were 3.8 (95% CI: 3.4, 4.3) for intentional injury and 4.6 (95% CI: 2.3, 9.2) for violent death, after adjustment. IPV victims experienced half the risk of subsequent intentional injury if the accused received a probation sentence. Our findings suggest that Justice involvement represents an opportunity for intersectoral collaborative prevention of subsequent intentional injury among IPV victims.

Impact of the COVID-19 shutdown on orthopedic trauma numbers and patterns in an academic Level I Trauma Center in Berlin, Germany

BACKGROUND

The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive.

METHODS

All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs).

FINDINGS

Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively.

CONCLUSIONS

While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.

Identifying patterns of health care utilisation among physical elder abuse victims using Medicare data and legally adjudicated cases: protocol for case-control study using data linkage and machine learning

INTRODUCTION

Physical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims.

METHODS AND ANALYSIS

We hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims' healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation.

ETHICS AND DISSEMINATION

This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.

Investigating the prevalence of intimate partner violence victimisation in women presenting to the emergency department in suicidal crisis

OBJECTIVE

To investigate the prevalence of intimate partner violence (IPV) and frequency of victimisation questioning by hospital staff in women presenting to EDs for suicide-related complaints and injuries.

METHODS

A cross-sectional survey design was used to assess IPV and ED experiences among women with a recent (<18 months) suicide-related presentation to EDs within six Local Health Districts across New South Wales. Women aged 16 years and over, residing in participating health districts were recruited in-person by hospital staff, or via Facebook advertisements. Variables assessed included demographic characteristics, psychosocial assessment coverage and exposure to IPV (Composite Abuse Scale [Revised]-Short-Form). Binary logistic regression was used to test for independent associations between variables on victimisation questioning by hospital staff.

RESULTS

A total of 563 women completed questionnaires following presentation to the ED for a suicide attempt (n = 329; 58%) or suicide crisis (n = 234; 42%). Of these, 200 women (36%) reported IPV exposure in the 18 months prior and 141 women (25%) reported earlier lifetime victimisation. Of the 341 women with a history of IPV, 155 women (45%) were asked about victimisation by hospital staff. Younger age and lower socio-economic status were significantly associated with questioning (P = 0.03).

CONCLUSION

Findings suggest a large proportion of women seeking support for suicide in the ED are affected by IPV, although few are asked about abuse experiences. Victimisation is associated with complex health issues and heightened mortality risk, which carry important implications for patient-care. Findings support routine ED screening and can be applied to stratify risk within IPV responses.

Addressing intimate partner violence during the COVID-19 pandemic and beyond: how radiologists can make a difference

Faced with the COVID-19 pandemic, many countries both in Europe and across the world implemented strict stay-at-home orders. These measures helped to slow the spread of the coronavirus but also led to increased mental and physical health issues for the domestically confined population, including an increase in the occurrence of intimate partner violence (IPV) in many countries. IPV is defined as behavior that inflicts physical, psychological, or sexual harm within an intimate relationship. We believe that as radiologists, we can make a difference by being cognizant of this condition, raising an alert when appropriate and treating suspected victims with care and empathy. The aim of this Special Report is to raise awareness of IPV among radiologists and to suggest strategies by which to identify and support IPV victims. KEY POINTS: • The COVID-19 pandemic led to a marked increase in the number of intimate partner violence (IPV) cases, potentially leading to increased emergency department visits and radiological examinations. • Most IPV-related fractures affect the face, fingers, and upper trunk, and may easily be misinterpreted as routine trauma. • Radiologists should carefully review the medical history of suspicious cases, discuss the suspicion with the referring physician, and proactively engage in a private conversation with the patient, pointing to actionable resources for IPV victims.

Intimate partner violence crisis in the COVID-19 pandemic: how can radiologists make a difference?

• The COVID-19 crisis resulted in a variety of physical and mental health issues beyond the viral infection itself, as indicated by an increase in domestic violence.

• Radiologists should be aware of typical intimate partner violence (IPV) injury patterns, actively ask potential IPV victims about the cause of injury, and be familiar with support systems for IPV victims of their institutions.

• Emergency and radiology departments should review their protocols for identifying and supporting IPV victims, and train their staff to work together to implement these measures during and beyond the COVID-19 crisis.

[Awareness training for domestic violence for medical professionals. Are they efficient too?]

BACKGROUND

According to studies conducted by the European Union, 33% of all women over the age of 15 are affected by domestic violence and tend to turn to the health care system to seek help. The experience of violence has serious consequences not only for the psychological, but also for the physical health of those affected. Except direct injury consequences, inexplicable pain, gastrointestinal discomfort or problems in the field of reproductive medicine can be observed, for example. With many of those affected turning to the health care system first in search of support, healthcare professionals also have a key role to play here, making sensitization training for professional groups increasingly important.

METHOD

Participants in awareness-raising training on domestic violence were interviewed before and after training with a questionnaire on their perceived safety in dealing with patients affected by violence.

RESULTS

The evaluation of a sensitization training at the Landeskrankenhaus Innsbruck showed significant improvements in the subjective sense of security in dealing with patients affected by violence.

CONCLUSION FOR PRACTICE

A clear structure of sensitization trainings with basic courses and advanced training seminars, as well as a focus on developing relationships and dealing with emotions, makes sense.

Violence and Emergency Department Use among Community-Recruited Women Who Experience Homelessness and Housing Instability

Women who experience housing instability are at high risk for violence and have disproportionately high rates of emergency department (ED) use. However, little has been done to characterize the violence they experience, or to understand how it may be related to ED use. We recruited homeless and unstably housed women from San Francisco shelters, free meal programs, and single room occupancy (SRO) hotels. We used generalized estimating equations to examine associations between violence and any ED use (i.e., an ED visit for any stated reason) every 6 months for 3 years. Among 300 participants, 44% were African-American, and the mean age was 48 years. The prevalence of violence experienced in the prior 6 months included psychological violence (87%), physical violence without a weapon (48%), physical violence with a weapon (18%), and sexual violence (18%). While most participants (85%) who experienced physical violence with a weapon or sexual violence in the prior 6 months had not visited an ED, these were the only two violence types significantly associated with ED use when all violence types were included in the same model (ORphysical/weapon = 1.83, 95% CI 1.02-3.28; ORsexual = 2.15, 95% CI 1.30-3.53). Only violence perpetrated by someone who was not a primary intimate partner was significantly associated with ED use when violence was categorized by perpetrator. The need to reduce violence in this population is urgent. In the context of health care delivery, policies to facilitate trauma-informed ED care and strategies that increase access to non-ED care, such as street-based medicine, could have substantial impact on the health of women who experience homelessness and housing instability.

Intimate Partner Violence Screening and Intervention: The American College of Preventive Medicine Position Statement

The purpose of this paper is to produce a position statement on intimate partner violence (IPV), a major sociomedical problem with recently updated evidence, systematic reviews, and U.S. Preventive Services Task Force guidelines. This position statement is a nonsystematic, rapid literature review on IPV incidence and prevalence, health consequences, diagnosis and intervention, domestic violence laws, current screening recommendations, barriers to screening, and interventions, focusing on women of childbearing age (15-45 years). The American College of Preventive Medicine (ACPM) recommends an integrated system of care approach to IPV for screening, identification, intervention, and ongoing clinical support. ACPM only recommends screening that is linked to ongoing clinical support for those at risk. ACPM recommends greater training of clinicians in IPV screening and interventions and offers health systems and research recommendations.

The effect of a course on violence against women on the attitudes of student midwives and nurses towards domestic violence against women, their occupational roles in addressing violence, and their abilities to recognize the signs of violence

AIM

The aim of this study was to determine the effect of a course on violence against women on the attitudes of student midwives and nurses towards violence against women and their abilities to recognize the signs of violence.

METHODS

This study used a pretest-posttest quasi-experimental design with experimental and control groups and was conducted with student midwives and nurses.

RESULTS

The results indicated that the difference between pretest and posttest scores averaged across three scales was statistically significant for students in the experimental group (P < 0.001) and not statistically significant for students in the control group ( P > 0.05).

PRACTICE IMPLICATIONS

The traditional attitudes of students who enrolled in the course on violence against women decreased, and their levels of knowledge of signs of violence increased.

Domestic violence victims in a hospital setting: prevalence, health impact and patients' preferences - results from a cross-sectional study

Background: Domestic violence (DV) is a widespread yet commonly underdetected problem with severe impact on physical and mental health. To date, only limited information is available on prevalence and detection-rates of victims of DV in hospital settings. Objective: The aim of this study was (a) to assess the prevalence and impact of DV on physical and mental health as well as risk-factors associated with it, (b) to determine how many patients had been asked directly about DV in the hospital and (c) to investigate patients' preferences about being asked about DV in a hospital setting. Methods: Adult inpatients and outpatients at seven somatic departments at the University Hospital Innsbruck (Austria) were included consecutively in this ad-hoc, cross-sectional paper-and-pencil questionnaire-based study. In total, n = 2,031 patients were assessed regarding their experiences with DV. They also reported on whether they had been asked about DV at the hospital and whether they would mind being asked about it. To evaluate the impact of DV on patients' self-reported physical and mental health, odds ratios were calculated using binary logistic regression. Results: DV was reported by 17.4% of patients, with 4.0% indicating current DV exposure. Lifetime DV exposure was associated with a significant risk for both physical and mental health-problems. Only 4.8% of patients with DV exposure had ever been asked about it by hospital staff. While patients with a history of DV were more open to being asked about DV than patients without DV (78.2% vs. 72.9%), overall acceptance was still high (74%). Conclusion: DV is a frequently overlooked problem with detrimental effects on physical and mental health. While high acceptance of DV assessment was found, only a small proportion of affected patients had indeed been assessed for DV. Screening for DV in hospitals may thus increase the number of identified patients.

Challenges of caring for victims of violence and their family members in the emergency department

INTRODUCTION

Interpersonal violence causes illness and suffering for victims and their family members. Emergency nurses are often given responsibility for forensic patients and their family members, but there is limited knowledge of their experiences regarding this task. This study aimed to describe nurses' experiences when caring for victims of violence and their family members in the emergency department.

METHODS

Individual interviews were conducted with twelve nurses from seven emergency departments. Data were analyzed using qualitative content analysis.

RESULTS

The analysis resulted in the theme: a challenge to create a caring encounter. Hindering factors comprising this challenge are described under four categories: struggling to intervene and talk about violence; contradictions when caring for family members; being helped by forensic guidelines but needing more knowledge; and dealing with one's own strong emotions towards violence.

DISCUSSION

Creating a caring encounter is perceived as a prerequisite to providing forensic care. Nurses often felt hindered to act and forensic issues were left unaddressed. Family members are offered little or no support in the aftermath of violence. The hindering factors must be overcome to ensure forensic care for victims of all types of violence.

Barriers to Screening Pregnant Women for Domestic Violence: A Cross-Sectional Study

Background information

Domestic Violence (DV) is associated with serious consequences to the survivor’s physical, emotional, sexual, social and mental well-being. DV screening ensures timely detection of violence and hence promotes timely intervention. This timely intervention has the potential of averting adverse outcomes of DV to the survivor. Globally, the prevalence of DV among women is 35% and in Kenya its 49% among women and 13.5% among pregnant women. Despite the adverse outcome of DV in pregnancy, screening during pregnancy lags behind in Kenya.

Purpose

To assess the nursing barriers to screening pregnant women for DV.

Methodology

A cross-sectional study of 125 nurses selected by random sampling method was conducted at a National Maternity Hospital in Kenya. Data was collected for 8 weeks using researchers developed structured questionnaire. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Chi-square test was used to determine significance of relationships between nominal variables. A P-value of ≤ 0.05 was considered significant.

Results

Study results revealed that 16% (n=8) of nurses routinely screened pregnant women for DV. Non-screening behavior of nurses was associated with lack of DV screening training during their education program (P=0.002), fear of the partner’s reaction (P=0.004) and lack of mentors and role models in DV screening (P=0.005). Lack of cooperation from other health professionals was also associated with non-screening of DV (P=0.016).

The significance of the study

The results of this study point to the need of developing hospital’s protocols on DV management and considering integrating DV screening in the routine medical screening of pregnant women during antenatal care.

Conclusion

The study showed that the nurse’s prevalence of screening pregnant women for DV is low at 16% due to various barriers.

Reliability and Validity of the “Extended - Hurt, Insult, Threaten, Scream” (E-Hits) Screening Tool in Detecting Intimate Partner Violence in Hospital Emergency Departments in Hong Kong

Objectives

To assess the reliability and validity of a brief screening instrument, “E-HITS” (Extended - Hurt, Insult, Threaten, Scream), for detecting female intimate partner violence (IPV) in Hong Kong emergency departments (EDs).

Method

Quantitative data were collected from a victim group (n=110) and a control group (n=116). Statistical properties of the instruments were analysed to ascertain its internal consistency, test/re-test reliability, concurrent validity and discriminant validity.

Results

Cronbach's alpha was 0.90 for the E-HITS. Two-week test/re-test reliability was 0.71 (p<0.001). Respondents' scores on the E-HITS positively correlated with those on psychological aggression, physical assault, sexual coercion and injury scales, and negatively correlated with the negotiation scale of the revised Conflict Tactics Scale at a statistically significant level. Subsequent Receiver Operating Characteristic (ROC) curve analysis revealed that E-HITS reached a sensitivity of 98.2% and a specificity of 94.8% at a cut-off of 8.5. The overall accuracy of the E-HITS indicated by the area under curve (AUC) in the ROC is 0.991.

Conclusion

These results show that the E-HITS has good internal consistency, test/re-test reliability, as well as concurrent and discriminant validity. The E-HITS is a valid and reliable tool for screening intimate partner violence in Hong Kong EDs.

Sociodemographic and Incident Variables as Predictors of Victim Injury From Intimate Partner Violence: Findings From Police Reports

Predictors of victim injury from intimate partner violence (IPV) were investigated using 1,292 police reports collected in South Carolina in 2009/2010. All cases were opposite sex adults. Results from bivariate statistics showed that IPV cases with ( n = 649) and without visible injuries ( n = 643) differed on victim gender, victim race, type of relationship, and perpetrator’s alcohol use. Results from a logistic regression analysis predicting victim injury showed higher odds ratios for males, Whites, and couples identified as cohabitants. Although most victims, including most injured victims, were Black women, males and Whites were overrepresented in the injured group.

Supporting female survivors of intimate partner violence with disabilities: Recommendations for social workers in the emergency department

Intimate partner violence (IPV) is a pervasive problem with grave consequences. Women with disabilities are among the most vulnerable groups disproportionately affected, with higher IPV rates than either women without disabilities or men with disabilities. The emergency department (ED) in particular affords a gateway into health services for female survivors of IPV, placing ED social workers in a prime position to observe potential signs of IPV and connect survivors to further assistance. This article explores the critical role ED social workers can fill in addressing the needs of female survivors of IPV with disabilities. We begin by providing background on the characteristics of IPV among women with disabilities, followed by a discussion of the opportunities and challenges inherent to assessing and intervening with survivors. We conclude by outlining recommendations for working with female survivors of IPV with disabilities in EDs, using our previous research on the topic as a guide.

Tensions and Ambivalent Feelings: Opinions of Emergency Department Employees About the Identification and Management of Intimate Partner Violence

The objective of this study was to examine factors facilitating and constraining the identification and management of intimate partner violence (IPV) at an emergency department (ED). Semi-structured interviews were conducted with 18 ED employees of a university hospital in the Netherlands. All interviews were audiotaped, transcribed verbatim, and analyzed by using qualitative content analysis in Atlas.ti. Constraining factors were lack of knowledge, awareness, and resources at the ED. ED employees felt many barriers to bringing up IPV. Facilitating factors were good cooperation among staff, the involvement of one team member in producing an IPV protocol, having received training on child abuse, and private consulting rooms. The ED setting and the ED employees' task perception and attitude contained both constraining and facilitating factors: ED employees saw it as their task and responsibility to help IPV victims, but their priorities were to secure a high turnover and treat acute physical problems. Although ED employees expressed openness and willingness to help, they also took the view that victims had a considerable responsibility of their own in disclosing and managing IPV, which led to ambivalent feelings. In conclusion, ED employees faced tensions in IPV identification and management caused by lack of awareness, knowledge and resources, conflicting priorities at the ED, and ambivalent feelings. Improvements can be made by supporting ED employees with guidelines in the form of a protocol and with training that also addresses the tensions ED employees face.

"… he always slaps me on my ears": the health consequences of intimate partner violence among a group of patrilineal women in Ghana

Intimate partner violence has implications for women's health globally. Patrilineal women have been shown to have increased risk of experiencing intimate partner violence, yet, the health consequences of intimate partner violence in patrilineal women have not been thoroughly explored or documented. This study used qualitative in-depth interviews to explore the health effects of intimate partner violence among 15 ever-partnered Ghanaian patrilineal women. Participants attributed violence to several factors including gendered domestic relations, cultural and marital rites and alcohol use, among other factors. Abused women reported health problems such as feelings of worthlessness, sleeplessness, suicidal ideation, eye injuries, bodily weakness, hypertension, genital sores and the premature termination of pregnancy. Policy makers should pay particular attention to intimate partner violence-related health consequences in designing health interventions for abused women.

Emergency Department Visits and Injury Hospitalizations for Female and Male Victims and Perpetrators of Intimate Partner Violence

Introduction. The potential for hospital-based interventions for male victims of intimate partner violence (IPV) as well as adult perpetrators of both genders has been largely unexplored despite early evidence of acute-care utilization that may be as high as female victims. The current investigation compared the emergency department (ED) and injury-related-hospitalization rates of IPV-involved individuals against standardized national norms, assessing differences by gender and victim/perpetrator-status. Methods. This cross-sectional study collected one-year ED and in-patient visit data from hospital records for individuals listed as victim or perpetrator in an IPV criminal charging request in a Midwestern county (N=2,937). Expected rates were calculated based upon age-adjusted national norms. Results. The IPV-involved population generated ED rates 4.1 times higher than expected and injury-related-hospitalization rates that were 4.0 times higher than expected. Bi-directionally-violent individuals (both victim and perpetrator in IPV charges) consistently had the highest utilization rates (ED 8.4 RR, injury-hospitalization 22.5 RR). Victims, primarily female, had higher ED-visits than perpetrators, primarily male (victims = 4.6 RR, perpetrator = 3.1 RR). Perpetrators, though, had higher injury hospitalizations (victims = 0.8RR, perpetrators = 5.5 RR). Conclusions. Substantial opportunities exist within acute-care medical settings to intervene with IPV-involved women, men, victims, and perpetrators, although the magnitude of the opportunity varied by setting, gender and victim/perpetrator-status.

Intimate partner violence: prevalence, health consequences, and intervention

Intimate partner violence (IPV) can be defined in many ways and encompasses many different types of physical and emotional abuse. IPV affects the health, safety, and quality of life for women, men, and children worldwide, regardless of race, sexual orientation, or socioeconomic status. The health effects include acute trauma; a wide range of physical and mental sequelae; and, for some, death. Because of the serious consequences of IPV, both the Centers for Disease Control and the World Health Organization identify IPV as a significant public health issue.

Evaluation of healthcare use trends of high-risk female intimate partner violence victims

Introduction

Practitioners need more information about intimate partner violence (IPV) victims’ healthcare use trends. We used a novel data-linkage method and complaint categorization allowing us to evaluate IPV victims healthcare use trends compared to the date of their victimization.

Methods

This was a retrospective case series using data-linking techniques cross-referencing databases of Medicaid-eligible women between the ages of 16 and 55 years, an IPV Case Database for 2007 and the Florida State Agency for Healthcare Administration, which tracks hospital inpatient, ambulatory and emergency department (ED) use within the State of Florida. We analyzed resulting healthcare visits 1.5 years before and 1.5 years after the women’s reported IPV offense. Using all available claims data a ‘complaint category’ representing categories of presenting chief complaints was assigned to each healthcare visit. Analysis included descriptive statistics, correlation coefficients between time of offense and visits, and a logistic regression analysis.

Results

The 695 victims were linked with 4,344 healthcare visits in the four-year study period. The victims were young (46% in the 16–25 age group and 79% were younger than 35). Healthcare visits were in the ED (83%) rather than other healthcare sites. In the ED, IPV victims mostly had complaint categories of obstetrics and gynaecology-related visits (28.7%), infection-related visits (18.9%), and trauma-related visits (16.3%). ED use escalated approaching the victim’s date of offense (r=0.59, p<0.0001) compared to use of non-ED sites of healthcare use (r=0.07, p=0.5817). ED use deescalated significantly after date of reported offense for ED visits (r=0.50, p<0.0001) versus non-ED use (r=0.00, p=0.9958). The victims’ age group more likely to use the ED than any other age group was the 36–45 age group (OR 4.67, CI [3.26–6.68]).

Conclusion

IPV victims use the ED increasingly approaching their date of offense. Presenting complaints were varied and did not reveal unique identifiers of IPV victims. This novel method of database matching between claims data and government records has been shown to be a valid way to evaluate healthcare utilization of at-risk populations.

Help-seeking patterns among women experiencing intimate partner violence: do they forgo the criminal justice system if their adjudication wishes are not met?

Following a criminal case disposition, an intimate partner violence (IPV) victim's willingness to seek future police and prosecutorial assistance may depend on her prior experiences within the system. This longitudinal study examines the relationship between IPV victims' future help-seeking based on past experiences. We hypothesized women would return to the criminal justice system if their adjudication wishes corresponded with prosecutors' actions. Contrary to the hypothesis, results suggest women return to the criminal system and other venues even if prosecutors' actions do not correspond to their earlier stated wishes. This has important policy implications given pro-prosecution protocols that encourage adjudication regardless of a woman's participation.

Screening and intervention for intimate partner violence in healthcare settings: creating sustainable system-level programs

Among the barriers to routine screening for intimate partner violence (IPV) are time constraints, a lack of protocols and policies, and departmental philosophies of care that may conflict with IPV screening recommendations. To address these barriers, systems-level interventions are needed; in this article, we describe one model that may overcome these obstacles. We discuss how this systemic approach may best be implemented in both out-patient clinics and emergency departments (EDs) and note that evidence for its success will be required.

Inpatient hospitalization and intimate partner violence: who are we treating?

BACKGROUND

The majority of research into health care use of intimate partner violence (IPV) has focused on female victims and primarily their emergency department use. There are limited data on injury-related hospitalization rates for female victims and even less for male victims and perpetrators. The goal of this study was to determine the annualized rates of inpatient injury-related hospitalization among individuals involved as either victims or defendants in IPV.

METHODS

This was an observational retrospective study linking data from two Level 1 trauma centers and the county prosecutor's office from 2000 to 2010 in Kalamazoo County, Michigan. (1) Hospital data included injury-related admissions (DRG International Classification of Diseases-9th Rev. codes 800-959.9 excluding 905-909.9). (2) Prosecutor data contained all charging requests for crimes between intimate partners. Annualized rates were calculated for the year before the IPV crime and for the year after, using the following algorithm: (number of hospitalizations) / (total population) × (per 10,000). Confidence intervals and two-sided statistical significance were calculated at the 95% confidence level.

RESULTS

During the study period, 21,179 IPV crimes were committed, involving 12,913 individual defendants and 14,797 victims. There were 30,301 injury-related hospitalizations by this group during this period. Compared with national hospitalization rates of 3.2 per 10,000 people for injury/poisoning (DRG International Classification of Diseases-9th Rev. 800-959.9 and 990-995), IPV victim annual admission rates were 31.9, defendants at 90.4, and bidirectional individuals at 339.1 per 10,000 people, in the 2 years surrounding the crime. Males, regardless of crime role, have higher injury-related hospitalization rates in this period compared with females (male, 115.6; female, 41.8). Males (victims or defendants) and bidirectional participants of either sex had rates that were significantly higher the year after than the year before the crime.

CONCLUSION

Individuals involved in IPV have a 10-fold higher injury-related hospitalization rate as compared with age-matched national rates. Admission rates vary by sex, crime role, and time frame, with males and bidirectional participants having the highest rates.

LEVEL OF EVIDENCE

Epidemiological study, level III.

Victim Participation in Intimate Partner Violence Prosecution

Are intimate partner violence (IPV) victims safer if they use the criminal justice system? Concerns about perpetrator retaliation, in the face of data that protection orders can reduce future harm, make it important to understand how victim utilization (calling 911, talking to the prosecutor, and proceeding with prosecution) affects subsequent safety. We hypothesized participation would improve victims’ safety, measured by decreases in subsequent IPV-related 911 calls and/or emergency department visits. Findings support contact with the prosecutor’s office was associated with reduction in police-reported IPV, regardless of the victim’s wish to proceed. Policy implications support pro-prosecution strategies coupled with victim contact.

Trauma-sensitive yoga as an adjunct mental health treatment in group therapy for survivors of domestic violence: a feasibility study

This study is a feasibility test of whether incorporating trauma-sensitive yoga into group therapy for female victims of partner violence improves symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) beyond that achieved with group therapy alone. Seventeen (9 control, 8 intervention) adult female clients seeking group psychotherapy were enrolled. A 12-week trauma-sensitive yoga protocol was administered once weekly for 30-40 min at the end of each group therapy session. The control group received typical group psychotherapy. Feasibility was assessed through recruitment and retention rates as well as participants' self-reported perceptions of the safety and utility of the study. The study enrolled 85% (17/20) of those screened eligible. Loss to follow-up was 30% (5/17). No one reported emotional or physical harm. All of the respondents reported that the study was personally meaningful and that the results would be useful to others.

Patterns, aetiology and risk factors of intimate partner violence-related injuries to head, neck and face in Chinese women

Background

Intimate partner violence (IPV) related injuries have been recognized among health care professionals. However, few studies have provided detailed information on injuries to the head, neck and face regions in Chinese women. As abused Chinese women are generally unwilling to disclose IPV and there are differences in socio-demographic characteristics, societal norms and behaviours, the women may exhibit different patterns, aetiology and risk factors of IPV-related HNF injuries. This study aims to examine the patterns of head, neck and face injuries presenting to Accident and Emergency departments, including the anatomical regions, types, severity, aetiology and demographic and non-demographic risk factors of injuries inflicted by intimate partners in Chinese context.

Methods

Medical charts of 223 women presented to the Accident and Emergency departments of two regional hospitals in Hong Kong between January 2010 and December 2011 were reviewed independently by two reviewers.

Results

Head, neck and face injuries remained the most common injuries found in abused Chinese women (77.6%), and punching with a fist was the most common aetiology (60.2%). In particular, punching with a fist was significantly associated on the upper third of the maxillofacial region (p = .01) and the back part of the head (p = .03). Moreover, cohabiting and separated women were more likely to have multiple injuries than those who were married (OR = 3.3, 95% CI = 1.4, 7.8; OR = 2.1, 95% CI = .4, 11.9).

Conclusions

The findings enhance the understanding of head, neck and face injuries and inform clinicians about the linkage among injuries and risks in abused Chinese women.

Evaluating current patterns of assessment for self-harm in emergency departments: a multicenter study

OBJECTIVES

The objective was to describe self-harm assessment practices in U.S. emergency departments (EDs) and to identify predictors of being assessed.

METHODS

This was a prospective observational cohort study of adults presenting to eight U.S. EDs. A convenience sample of adults presenting to the EDs during covered research shifts was entered into a study log. Self-harm assessment was defined as ED documentation of suicide attempt; suicidal ideation; or nonsuicidal self-injury thoughts, behaviors, or both. Institution characteristics were compared relative to percentage assessed. To identify predictive patient characteristics, multivariable generalized linear models were created controlling for weekend presentation, time of presentation, age, sex, and race and ethnicity.

RESULTS

Among 94,354 charts, self-harm assessment ranged from 3.5% to 31%, except for one outlying site at 95%. Overall, 26% were assessed (11% excluding the outlying site). Current self-harm was present in 2.7% of charts. Sites with specific self-harm assessment policies had higher assessment rates. In the complete model, adjusted risk ratios (aRR) for assessment included age ≥ 65 years (0.56, 95% confidence interval [CI] = 0.35 to 0.92) and male sex (1.17, 95% CI = 1.10 to 1.26). There was an interaction between these variables in the smaller model (excluding outlying site), with males < 65 years of age being more likely to be assessed (aRR = 1.14, 95% CI = 1.02 to 1.37).

CONCLUSIONS

Emergency department assessment of self-harm was highly variable among institutions. Presence of specific assessment policies was associated with higher assessment rates. Assessment varied based upon patient characteristics. The identification of self-harm in 2.7% of ED patients indicates that a substantial proportion of current risk of self-harm may go unidentified, particularly in certain patient groups.

Use of emergency department services by women victims of violence in Lazio region, Italy

BACKGROUND

Violence against women is a significant health problem and a hidden phenomenon, in Italy that about 31% of the women have been victims of violence once in life. Aims of this study are to describe characteristics of women victims of violence (VV) attending the EDs in the Lazio region in 2008 and to illustrate the frequency and characteristics of previous ED visits.

METHODS

Using the Emergency Information System, visits of women, (15-49 years), in the 60 EDs, for a violent trauma have been analysed. For each VV identified, we considered the last episode and searched for ED attendances in a six year period (2003-08) in order to identify other visits. We performed descriptive analyses of socio-demographic and clinical factors of VV and we analyzed the impact previous ED visits. We compared ED utilization of women VV with a random sample of women with the same age distribution who gave birth in 2008.

RESULTS

In 2008, 7,725 ED attendances of women VV were found (1.1% of the ED visits) corresponding to 6,936 women (prevalence = 52.0x10,000). The mean number of ED visits for each woman in five years was 5.0 (1-190). Prevalent diagnoses were contusions (45.8%), neurotic disorders (5.4%) complications of medical care (6.3%). The women were young, approximately 70% were residents in Rome or the surrounding areas. Foreign women were three times more likely to visit the ED for intentional injuries than were Italian women (114.1 vs 44.4 per 10.000).

CONCLUSIONS

This study shows high prevalence of violence against women in Lazio region, Italy. Most of the women have been visited by the ED several times before the violent episode, often with traumas. ED medical and nursing staff should be prepared and trained to successfully manage victims of violence.