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Scott S, Brameier DT, Tryggedsson I, Suneja N, Stenquist DS, Weaver MJ, von Keudell A. Intimate partner violence: An updated review of prevalence, identification, and screening tools for orthopaedic surgeons and training in medical education. Injury 2024; 55:111800. [PMID: 39121806 DOI: 10.1016/j.injury.2024.111800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/17/2024] [Accepted: 08/03/2024] [Indexed: 08/12/2024]
Abstract
Intimate partner violence is an overlooked, underestimated, and under reported cause of musculoskeletal injury. This literature review aims to provide an updated overview of the prevalence of IPV, along with the identification and screening tools available to orthopaedic surgeons for early detection and intervention. Additionally, the review discusses the importance of training in medical education for orthopaedic surgeons to effectively recognize and address IPV. Through an analysis of current research and best practices, this review highlights the need for increased awareness, education, and collaboration among healthcare professionals to effectively address IPV as a public health issue.
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Affiliation(s)
- Sophia Scott
- Harvard University, Human Evolutionary Biology, Cambridge, MA, USA; Brigham and Women's Hospital, Orthopaedic Surgery, Boston, MA, USA.
| | - Devon T Brameier
- Brigham and Women's Hospital, Orthopaedic Surgery, Boston, MA, USA
| | - Ida Tryggedsson
- Bispebjerg Hospital, Orthopaedic Surgery, Copenhagen, Denmark
| | - Nishant Suneja
- Brigham and Women's Hospital, Orthopaedic Surgery, Boston, MA, USA
| | | | - Michael J Weaver
- Brigham and Women's Hospital, Orthopaedic Surgery, Boston, MA, USA
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Melhado C, Decker H, Schwab M, Kaki DA, Shao S, Harrison JD, Bongiovanni T. Barriers and facilitators to screening for intimate partner violence at a level 1 trauma center. Surgery 2024:S0039-6060(24)00552-X. [PMID: 39174441 DOI: 10.1016/j.surg.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/08/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Intimate partner violence (IPV) is a significant public health problem that is associated with substantial health sequelae, including traumatic injury. Surgical professional societies recommend universal intimate partner violence screening in patients presenting after trauma, but this recommendation is not uniformly implemented. We designed and implemented a quality improvement project at our institution in July 2020 to enhance intimate partner violence screening. Although screening rates improved, they remained suboptimal. Therefore, we sought to examine barriers and facilitators to intimate partner violence screening from trauma clinicians' perspectives. STUDY DESIGN We conducted a qualitative study using in-depth, semistructured interviews to understand the perspectives and experiences of trauma clinicians conducting intimate partner violence screening. A constructivist paradigm informed our study whereby our data collection approaches aimed to understand intimate partner violence screening from the perspectives of those tasked with implementing screening within real-world clinical settings. We used thematic analysis to analyze our data and generate themes related to barriers and facilitators to screening. RESULTS We conducted interviews with 12 resident physicians and 2 advance practice providers. We identified 6 themes, 3 reflecting facilitator themes as (1) standardized education and workflow, (2) benefits of interdisciplinary teamwork, and (3) context of screening, and 3 reflecting barrier themes as (1) lack of time, (2) language misinterpretation, and (3) perceived inappropriateness of universal screening. CONCLUSION Trauma clinicians described multiple facilitators and barriers to screening for intimate partner violence following traumatic injury, some of which were unique to the trauma setting. Projects seeking to achieve universal screening following traumatic injury may benefit from accounting for these factors when designing interventions.
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Affiliation(s)
- Caroline Melhado
- Department of Surgery, University of California, San Francisco, CA
| | - Hannah Decker
- Department of Surgery, University of California, San Francisco, CA.
| | - Marisa Schwab
- Department of Surgery, University of California, San Francisco, CA
| | - Dahlia A Kaki
- School of Medicine, University of California, San Francisco, CA
| | - Shirley Shao
- School of Medicine, University of California, San Francisco, CA
| | - James D Harrison
- Division of Hospital Medicine, University of California, San Francisco, CA
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Svensson Malchau K, Caragounis EC, Sundfeldt M. DORIS study: domestic violence in orthopaedics, a prospective cohort study at a Swedish hospital on the annual prevalence of domestic violence in orthopaedic emergency care. BMJ Open 2024; 14:e085618. [PMID: 38719290 PMCID: PMC11086206 DOI: 10.1136/bmjopen-2024-085618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Domestic violence (DV) is a major problem which despite many efforts persists globally. Victims of DV can present with various injuries, whereof musculoskeletal presentation is common. OBJECTIVES The DORIS study (Domestic violence in ORthopaedIcS) aimed to establish the annual prevalence of DV at an orthopaedic emergency department (ED) in Sweden. DESIGN Female adult patients with orthopaedic injuries seeking treatment at a tertiary orthopaedic centre between September 2021 and 2022 were screened during their ED visit. SETTING This is a single-centre study at a tertiary hospital in Sweden. PARTICIPANTS Adult female patients seeking care for acute orthopaedic injuries were eligible for the study. During the study period, 4192 female patients were provided with study forms and 1366 responded (32.5%). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was to establish the annual prevalence of injuries due to DV and second, to establish the rate of current experience of any type of DV. RESULTS One in 14 had experience of current DV (n=100, 7.5%) and 1 in 65 (n=21, 1.5%) had an injury due to DV. CONCLUSIONS The prevalence of DV found in the current study is comparable to international findings and adds to the growing body of evidence that it needs to be considered in clinical practice. It is important to raise awareness of DV, and frame strategies, as healthcare staff have a unique position to identify and offer intervention to DV victims.
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Affiliation(s)
- Karin Svensson Malchau
- Department of Orthopaedics, Insitute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Corina Caragounis
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sundfeldt
- Department of Orthopaedics, Insitute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Decker H, Schwab M, Shao S, Kaki D, Melhado C, Cuschieri J, Bongiovanni T. Screening for Intimate Partner Violence in Trauma: Results of a Quality Improvement Project. J Surg Res 2024; 295:376-384. [PMID: 38064979 DOI: 10.1016/j.jss.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Intimate partner violence (IPV) is common, especially among patients presenting with traumatic injury. We implemented an IPV screening program for patients admitted after trauma. We sought to determine whether specific demographic or clinical characteristics were associated with being screened or not screened for IPV and with IPV screen results. METHODS Retrospective cohort study evaluating all patients admitted after trauma from July 2020-July 2022 in an Adult Level 1 Trauma Center. RESULTS There were 4147 admissions following traumatic injury, of which 70% were men and 30% were women. The cohort was 46% White, 20% Asian, 15% Black, and 17% other races. Twenty-three percent were Hispanic or Latino/a. Seventy-seven percent were admitted for blunt injuries and 16% for penetrating injuries. Thirteen percent (n = 559) of the cohort was successfully screened for IPV. Screening rates did not differ by gender, race, or ethnicity. After adjustment for demographic and clinical factors, patients admitted to the intensive care unit were significantly less likely to be screened. Of the screened patients, 30% (165) screened positive. These patients were more commonly Hispanic or Latino/a, insured by Medicaid and presented with a penetrating injury. There were no differences in injury severity in patients who screened positive versus those who screened negative. CONCLUSIONS There are significant barriers to universal screening for IPV, including injury acuity, in patients admitted following trauma. However, the 30% rate of positive screens for IPV in patients admitted following trauma highlights the urgent need to understand and address barriers to screening in trauma settings to enable universal screening.
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Affiliation(s)
- Hannah Decker
- Department of Surgery, University of California at San Francisco, San Francisco, California.
| | - Marisa Schwab
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Shirley Shao
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Dahlia Kaki
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Caroline Melhado
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Joseph Cuschieri
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Tasce Bongiovanni
- Department of Surgery, University of California at San Francisco, San Francisco, California
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Irish K, Madden K. Cochrane in CORR ® : Psychological Therapies for Women Who Experience Intimate Partner Violence. Clin Orthop Relat Res 2023; 481:2091-2097. [PMID: 37707505 PMCID: PMC10567031 DOI: 10.1097/corr.0000000000002838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Kim Irish
- Research Institute of St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Kim Madden
- Research Institute of St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
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Kunes JA, Ulrich MN, Orr CE, Cannada LK, Russo CM. Intimate Partner Violence in the Orthopaedic Patient Population: What Surgeons Need to Know. JBJS Rev 2023; 11:01874474-202304000-00006. [PMID: 37079704 DOI: 10.2106/jbjs.rvw.22.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
» 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.
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Affiliation(s)
- Jennifer A Kunes
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Marisa N Ulrich
- Department of Orthopedic Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Charlotte E Orr
- Department of Orthopedic Surgery, Miami Valley Hospital, Terre Haute Regional Hospital, Dayton, Ohio
| | - Lisa K Cannada
- Department of Orthopaedic Surgery, Novant Health Orthopaedics, Charlotte, North Carolina
| | - Christen M Russo
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Lam H, Harshaw N, Bresz K, Brown CT, Perea LL. Social Determinants of Health in Trauma. Am Surg 2023:31348231160845. [PMID: 36924199 DOI: 10.1177/00031348231160845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Social determinants (SD) refer to a variety of environmental factors that can influence certain clinical outcomes. SD that affect clinical outcomes in trauma patients are largely understudied. We hypothesized that patients with an "at risk" (AR) classification for any SD will have a greater frequency of negative outcomes when compared to their "not at risk" (NAR) counterparts. A retrospective review was performed (1/2021-2/2022) of all trauma patients that met the inclusion criteria. 2225 patients were included. SD included (based on collection rates) for analysis were: tobacco use, stress, and intimate partner violence. Tobacco usage was the only SD that was significantly associated with a higher 30-day mortality. This study demonstrated a paucity of data in the medical record regarding SD. In an effort to provide more inclusive care and address health disparities in our patient population, there is a need for more complete data collection upon admission/duration of hospital stay.
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Affiliation(s)
- Hoi Lam
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Nate Harshaw
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Kellie Bresz
- Business Intelligence, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Catherine Ting Brown
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Lindsey L Perea
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
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Turkstra LS, Salanki K, MacIntyre E, Kim N, Jin J, Sprague S, Scott T, Bhandari M. What Is the Prevalence of Intimate Partner Violence and Traumatic Brain Injury in Fracture Clinic Patients? Clin Orthop Relat Res 2023; 481:132-142. [PMID: 36200843 PMCID: PMC9750668 DOI: 10.1097/corr.0000000000002329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Individuals in violent intimate relationships are at a high risk of sustaining both orthopaedic fractures and traumatic brain injury (TBI), and the fracture clinic may be the first place that concurrent intimate partner violence (IPV) and TBI are recognized. Both IPV and TBI can affect all aspects of fracture management, but prevalence of TBI and comorbid TBI and IPV is unknown. QUESTIONS/PURPOSES (1) What are the previous-year and lifetime prevalence of IPV and TBI in women presenting to an outpatient orthopaedic fracture clinic? (2) What are the conditional probabilities of TBI in the presence of IPV and the reverse, to explore whether screening for one condition could effectively identify patients with the other? (3) Do patients with TBI, IPV, or both have worse neurobehavioral symptoms than patients without TBI and IPV? METHODS The study was completed in the fracture clinic at a community Level 1 trauma center in Southern Ontario from July 2018 to March 2019 and included patients seen by three orthopaedic surgeons. Inclusion criteria were self-identification as a woman, age 18 years or older, and the ability to complete forms in English without assistance from the person who brought them to the clinic (for participant safety and privacy). We invited 263 women to participate: 22 were ineligible (for example, they were patients of a surgeon who was not on the study protocol), 87 declined before hearing the topic of the study, and data from eight were excluded because the data were incomplete or lost. Complete data were obtained from 146 participants. Participants' mean age was 52 ± 16 years, and the most common diagnosis was upper or lower limb fracture. Prevalence of IPV was calculated as the number of women who answered "sometimes" or "often" to direct questions from the Woman Abuse Screening Tool, which asks about physical, emotional, and sexual abuse in the past year or person's lifetime. The prevalence of TBI was calculated as the number of women who reported at least one head or neck injury that resulted in feeling dazed or confused or in loss of consciousness lasting 30 minutes or less on the Ohio State University Traumatic Brain Injury Identification Method, a standardized procedure for eliciting lifetime history of TBI through a 3- to 5-minute structured interview. Conditional probabilities were calculated using a Bayesian analysis. Neurobehavioral symptoms were characterized using the Neurobehavioral Symptom Inventory, a standard self-report measure of everyday emotional, somatic, and cognitive complaints after TBI, with total scores compared across groups using a one-way ANOVA. RESULTS Previous-year prevalence of physical IPV was 7% (10 of 146), and lifetime prevalence was 28% (41 of 146). Previous-year prevalence of TBI was 8% (12 of 146), and lifetime prevalence was 49% (72 of 146). The probability of TBI in the presence of IPV was 0.77, and probability of IPV in the presence of TBI was 0.36. Thus, screening for IPV identified proportionately more patients with TBI than screening for TBI, but the reverse was not true. Neurobehavioral Symptom Inventory scores were higher (more symptoms) in patients with TBI only (23 ± 16) than those with fractures only (12 ± 11, mean difference 11 [95% CI 8 to 18]; p < 0.001), in those with IPV only (17 ± 11) versus fractures only (mean difference 5 [95% CI -1 to -11]; p < 0.05), and in those with both TBI and IPV (25 ± 14) than with fractures only (mean difference 13 [95% CI 8 to 18]; p < 0.001) or those with IPV alone (17 ± 11, mean difference 8 [95% CI -1 to 16]; p < 0.05). CONCLUSION Using a brief screening interview, we identified a high self-reported prevalence of TBI and IPV alone, consistent with previous studies, and a novel finding of high comorbidity of IPV and TBI. Given that the fracture clinic may be the first healthcare contact for women with IPV and TBI, especially mild TBI associated with IPV, we recommend educating frontline staff on how to identify IPV and TBI as well as implementing brief screening and referral and universal design modifications that support effective, efficient, and accurate communication patients with TBI-related cognitive and communication challenges. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Lyn. S. Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, ON, Canada
| | - Krista Salanki
- Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, ON, Canada
| | - Emily MacIntyre
- Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, ON, Canada
| | - Noel Kim
- Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, ON, Canada
| | - Jonathan Jin
- Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, ON, Canada
| | - Sheila Sprague
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Taryn Scott
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Al Maskari S. Women Recovering from Musculoskeletal Injury Are at Increased Risk for Intimate Partner Violence: Commentary on an article by Kim Madden, PhD, et al.: "Intimate Partner Violence During Recovery from an Orthopaedic Injury. An Exploratory, Prospective, Multicenter, Observational Cohort Study". J Bone Joint Surg Am 2022; 104:e24. [PMID: 35293893 DOI: 10.2106/jbjs.21.01463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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