Supporting victims of violent crime

Craniofacial trauma presenting at an adult accident and emergency department with an emphasis on soft tissue injuries

We have retrospectively compiled data on 1000 consecutive adult patients presenting at an accident and emergency department (AED) with a total of 1048 soft tissue injuries and 151 fractures to the craniofacial region, with an emphasis on soft tissue injuries. Facial injuries were common in the AED, forming 7% of all attenders. The main cause of facial fractures was assaults (56%), whereas the largest proportion of soft tissue injuries was caused by falls/ accidents (44%). There was a left sided dominance in soft tissue injuries arising from assaults. However, when subdivided into type of soft tissue injuries, the left sided dominance was significant in contusions only, with virtually equal side distribution in open wounds. Almost half of the 458 open wounds which required treatment were in the upper third of the face. Most lacerations in the upper face can be managed by steristrips or glue but most lacerations in the lower third required suturing. 90% of these injuries were treated by AED personnel. Tertiary referrals were made in only 10% of these cases.

Vulnerability, victims and violence

The burden on accident and emergency (A&E) departments of dealing with the aftermath of violence has increased substantially in the last 10 years. Both the underlying causes and the effects on the injured are multifaceted. It is important that clinicians who treat the injured know which interventions, like early family support and preschool education, are effective in preventing violence. It is also important to target those who will benefit from interventions to prevent, for example, serious psychological sequelae or further alcohol related harm. As with child protection, the organisation of services for adults needs to be built on teamwork with other agencies, particularly so that the injured are assessed for risk of future harm and are given opportunities to report offences to the police if they wish. Up to now, the contribution of A&E doctors to dealing with violence has been largely reactive. This policy paper argues that since many of the underlying causes and circumstances of violence can be modified, a more proactive, interagency approach would be effective in the fight against violence.

A prospective study of assault victims attending a suburban A&E department

This prospective study was undertaken to assess demographic and social factors, assault characteristics and injuries sustained by assault victims attending a suburban A & E department. A total of 214 men and women who admitted to having been assaulted were entered into the study, information being obtained by patient questionnaire and from A&E records. The assault victims made up 3.3% of the total new patients seen in the study period. The majority of victims were employed, single young men (72%) who had been drinking alcohol prior to assault (66%). They were assailed late at night in the street, in pubs and clubs. Female domestic assault was two times more common in this population than in previous British studies, and women were more extensively injured than men. Injuries were mostly to the face, caused by punches and kicks. Overall, 72% of fractures were facial. Most patients were referred to their G. P. for follow up (41%). The available evidence suggests that personal violence is on the increase, and is not confined to inner-City areas. As victims seeking help will usually attend an A&E department, staff should be alerted to recognize and advise these patients on possible psychological sequelae, as well as treating their physical injuries.