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Prakash J, Fay K, Gujrathi R, Rosner B, Nour N, Khurana B. Antepartum Intimate Partner Violence: Development of a Risk Prediction Model. J Womens Health (Larchmt) 2024. [PMID: 38770781 DOI: 10.1089/jwh.2024.0038] [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: 05/22/2024] Open
Abstract
Objectives: To explore socio-behavioral, clinical, and imaging findings associated with antepartum intimate partner violence (IPV) and aid in risk stratification of at-risk individuals. Methods: We analyzed electronic medical records during indexed pregnancies for 108 pregnant patients who self-reported antepartum IPV (cases) and 106 age-matched pregnant patients who did not self-report antepartum IPV (controls). Sociodemographic, clinical, and radiology data were analyzed via chi-squared and Fisher's exact tests with p < 0.05 as the threshold for significance. Stepwise logistic regression was applied to derive a risk prediction model. Results: The proportion of cases reporting emotional IPV (76% vs. 52%) and/or physical IPV (45% vs. 31%) during pregnancy significantly increased from prior to pregnancy. Cases were significantly more likely to report prepregnancy substance use (odds ratio [OR] = 2.60; 95% confidence interval [CI]: 1.13-5.98), sexually transmitted infections (OR = 3.48; 95%CI: 1.64-7.37), abortion (OR = 3.17; 95%CI: 1.79, 5.59), and preterm birth (OR = 5.97; 95%CI: 1.69-21.15). During pregnancy, cases were more likely to report unstable housing (OR = 5.26; 95%CI: 2.67-10.36), multigravidity (OR = 2.83; 95%CI: 1.44-5.58), multiparity (OR = 3.75; 95%CI: 1.72-8.20), anxiety (OR = 3.35; 95%CI: 1.85-6.08), depression (OR = 5.58; 95%CI: 3.07-10.16), substance use (OR = 2.92; 95%CI: 1.28-6.65), urinary tract infection (UTI) (OR = 3.26; 95%CI: 1.14-9.32), intrauterine growth restriction (OR = 10.71; 95%CI: 1.35-85.25), and cesarean delivery (OR = 2.25; 95%CI: 1.26-4.02). Cases had significantly more OBGYN abnormalities on imaging and canceled more radiological studies (OR = 5.31). Logistic regression found housing status, sexually transmitted infection history, preterm delivery history, abortion history, depression, and antepartum UTI predictive of antepartum IPV. The risk prediction model achieved good calibration with an area under the curve of 0.79. Conclusions: This study identifies significant disparities among patients experiencing antepartum IPV, and our proposed risk prediction model can inform risk assessment in this setting.
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Affiliation(s)
- Jaya Prakash
- Trauma Imaging Research and Innovation Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kathryn Fay
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rahul Gujrathi
- Trauma Imaging Research and Innovation Center, Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Nawal Nour
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bharti Khurana
- Trauma Imaging Research and Innovation Center, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Khurana B, Prakash J, Lewis-O'Connor A, Green W, Rexrode KM, Loder RT. Assault-related anoxia and neck injuries in US emergency departments. Inj Prev 2024; 30:188-193. [PMID: 38071575 PMCID: PMC11220620 DOI: 10.1136/ip-2023-045107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/18/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND Early identification of non-fatal strangulation in the context of intimate partner violence (IPV) is crucial due to its severe physical and psychological consequences for the individual experiencing it. This study investigates the under-reported and underestimated burden of IPV-related non-fatal strangulation by analysing assault-related injuries leading to anoxia and neck injuries. METHODS An IRB-exempt, retrospective review of prospectively collected data were performed using the National Electronic Injury Surveillance System All Injury Programme data from 2005 to 2019 for all assaults resulting in anoxia and neck injuries. The type and mechanism of assault injuries resulting in anoxia (excluding drowning, poisoning and aspiration), anatomical location of assault-related neck injuries and neck injury diagnosis by morphology, were analysed using statistical methods accounting for the weighted stratified nature of the data. RESULTS Out of a total of 24 493 518 assault-related injuries, 11.6% (N=2 842 862) resulted from IPV (defined as perpetrators being spouses/partners). Among 22 764 cases of assault-related anoxia, IPV accounted for 40.4%. Inhalation and suffocation were the dominant mechanisms (60.8%) of anoxia, with IPV contributing to 41.9% of such cases. Neck injuries represented only 3.0% of all assault-related injuries, with IPV accounting for 21% of all neck injuries and 31.9% of neck contusions. CONCLUSIONS The study reveals a significant burden of IPV-related anoxia and neck injuries, highlighting the importance of recognising IPV-related strangulation. Comprehensive screening for IPV should be conducted in patients with unexplained neck injuries, and all IPV patients should be screened for strangulation events.
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Affiliation(s)
- Bharti Khurana
- Trauma Imaging Research and Innovation Center, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jaya Prakash
- Trauma Imaging Research and Innovation Center, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Annie Lewis-O'Connor
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William Green
- The Training Institute on Strangulation Prevention, Shingle Springs, California, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Randall T Loder
- Orthopaedic Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
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3
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Saenz NM, Tallman SD. Fracture variation in survivable versus fatal blunt force trauma associated with intimate partner violence. Forensic Sci Int 2024; 357:112000. [PMID: 38518565 DOI: 10.1016/j.forsciint.2024.112000] [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: 10/09/2023] [Revised: 01/24/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
Intimate partner violence (IPV) is a global human rights issue that affects approximately 25% of women and 10% of men and is the leading cause of homicides of women worldwide. Multiple interventional studies have been conducted to screen for IPV; however, fractures associated with intimate partner homicide (IPH) have not been studied from a forensic anthropological perspective. Therefore, this study uses computed tomography scans of IPH victims (n=33) obtained from the New Mexico Office of the Medical Investigator to 1) classify and quantify perimortem craniofacial blunt force fractures, and 2) compare the IPH-related fractures to those associated with non-lethal IPV using previously published studies. The results indicate that IPH cases presented similarly to non-lethal IPV cases in that they were concentrated on the middle and lower face, but fractures were more frequent in the upper face and cranial vault in IPH cases. While IPH cases showed more fractures, they were not necessarily associated with extensive fracturing, as 75.8% of IPH victims had five or fewer fractures-the most common being comminuted and linear fractures, comprising 93.8% of IPH-related fractures. As IPV is significantly underreported, understanding the nuances of fracture patterns associated with IPH can help to aid holistic forensic investigations.
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Affiliation(s)
- Nicole M Saenz
- Applied EarthWorks, Inc., 1391 West Shaw Avenue Fresno, CA 93711, USA; Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St. L1004, Boston, MA 02118, USA
| | - Sean D Tallman
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord St. L1004, Boston, MA 02118, USA; Department of Anthropology, Boston University, 232 Bay State Rd. #105, Boston, MA 02215, USA.
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Dako F, Holden N, Narayan A, Guerra C. Understanding Health-Related Social Risks. J Am Coll Radiol 2024:S1546-1440(24)00280-1. [PMID: 38461918 DOI: 10.1016/j.jacr.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
Because of the established contribution of social factors to health outcomes, approaches that address upstream determinants of health have increasingly been recognized as cost-effective means to improve population health. Understanding and usage of precise terminology is important to facilitate collaboration across disciplines. Social determinants of health affect everyone, not just the socially and economically disadvantaged, whereas health-related social risks (HRSR) are specific adverse conditions at the individual or family level that are associated with poor health and related to the immediate challenges individuals face. Health-related social needs account for patient preference in addressing identified social risks. The use of validated screening tools is important to capture risk factors in a standardized fashion to support research and quality improvement. There is a paucity of studies that address HRSR in the context of radiology. This review provides an understanding of HRSR and outlines various ways in which radiologists can work to mitigate them.
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Affiliation(s)
- Farouk Dako
- Director, Center for Global and Population Health Research in Radiology, Senior Fellow, Leonard Davis Institute of Health Economics, and Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Natasha Holden
- College of Osteopathic Medicine of the Pacific Western University of Health Sciences, Pomona, California
| | - Anand Narayan
- Vice Chair, Health Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carmen Guerra
- Vice Chair of Diversity and Inclusion, Department of Medicine, and Associate Director of Diversity and Inclusion, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Tang A, Wong A, Khurana B. Imaging of Intimate Partner Violence, From the AJR Special Series on Emergency Radiology. AJR Am J Roentgenol 2023; 220:476-485. [PMID: 36069484 DOI: 10.2214/ajr.22.27973] [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: 01/26/2023]
Abstract
Intimate partner violence (IPV) is a highly prevalent public health issue with multiple adverse health effects. Radiologists are well suited to assessing a patient's likelihood of IPV. Recognition of common IPV injury mechanisms and resulting target and defensive injury patterns on imaging and understanding of differences between patients who have experienced IPV and those who have not with respect to use of imaging will aid radiologists in accurate IPV diagnosis. Target injuries often involve the face and neck as a result of blunt trauma or strangulation; defensive injuries often involve an extremity. Awareness of differences in injury patterns resulting from IPV-related and accidental trauma can aid radiologists in detecting a mismatch between the provided clinical history and imaging findings to support suspicion of IPV. Radiologists should consider all available current and prior imaging in assessing the likelihood of IPV; this process may be aided by machine learning methods. Even if correctly suspecting IPV on the basis of imaging, radiologists face challenges in acting on that suspicion, including appropriately documenting the findings, without compromising the patient's confidentiality and safety. However, through a multidisciplinary approach with appropriate support mechanisms, radiologists may serve as effective frontline physicians for raising suspicion of IPV.
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Affiliation(s)
- Anji Tang
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
- Trauma Imaging Research and Innovation Center, Brigham and Women's Health, Boston, MA
| | - Andrew Wong
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
- Trauma Imaging Research and Innovation Center, Brigham and Women's Health, Boston, MA
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Prakash J, Markert T, Bain PA, Stoklosa H. Maternal Health Concerns for Pregnant Labor-Trafficked People: A Scoping Review. J Immigr Minor Health 2023:10.1007/s10903-023-01466-5. [PMID: 36920583 DOI: 10.1007/s10903-023-01466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/16/2023]
Abstract
We set out to map the (1) living/occupational hazards, (2) health outcomes, and (3) barriers to care that exist for pregnant labor-trafficked people. Eight databases were systematically searched based on inclusion criteria. Five papers were eligible for inclusion. Data on study characteristics, social determinants, hazardous exposures, health outcomes, and barriers to care were extracted and synthesized. Common risk factors and occupational/living hazards were identified. Both were thematically connected with barriers to care and a host of adverse health outcomes. More importantly, a significant gap was discovered with no disaggregated quantitative data on the experience of pregnancy among labor-trafficked people. The interaction of risk factors, occupational/living hazards, and barriers to care experienced by pregnant labor-trafficked people may influence their susceptibility to adverse health outcomes. We need population-based studies, informed by those with lived experience of labor trafficking to examine the experience of pregnancy for labor-trafficked people to improve intervention and support efforts for this population.
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Affiliation(s)
- Jaya Prakash
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Tahireh Markert
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Paul A Bain
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Countway Library, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Hanni Stoklosa
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,HEAL Trafficking, 236 Ximeno Avenue, Long Beach, CA, 90803, USA
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Watane GV, Tang A, Thomas R, Park H, Gujrathi R, Gosangi B, Khurana B. Imaging Findings on Head Computed Tomography Scans in Victims of Intimate Partner Violence. J Comput Assist Tomogr 2023; 47:307-314. [PMID: 36790916 DOI: 10.1097/rct.0000000000001427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The aim of the study is to analyze the imaging findings and injury patterns seen on head computed tomography (CT) examinations performed on survivors of intimate partner violence (IPV). METHODS An institutional review board-approved retrospective analysis of 668 patients reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 40 unique patients with radiological findings visible on head CT. All injuries visible on head CT were analyzed based on the anatomic location and injury type. Demographics, IPV screening at the time of injury, concomitant, prior, and subsequent injuries to the index head injury were also recorded. RESULTS Our study cohort had 36 women and 4 men with a mean age at presentation of 43 ± 13 years (mean ± SD), 91 unique injuries with 57 (62.6%) isolated soft tissue injuries, 4 (3.2%) fractures, 13 (14.3%) intra-axial, and 17 (18.7%) extra-axial injuries. Soft tissue injuries and intra-axial injuries occurred most commonly in the frontal region (45.6% and 38.5%), followed by the parietal region (22.8% and 23.1%), while most extra-axial injuries were subdural hematomas (41.2%). Left-sided injuries accounted for 49% (45/91) with 29/91 right-sided (32%) and 17/91 bilateral (19%) injuries. The IPV screening occurred in 44% of injury visits (22/50). Concomitant injuries were seen in 14/50 injury visits (28%), most commonly being in the lower extremity (6/14, 42.9% [% of visits with concomitant injuries]) followed by the upper extremity (5/14, 35.7%), while 52% of visits (26/50) were preceded by prior injuries and 68% of events (34/50) were followed by subsequent injuries. CONCLUSIONS Isolated soft tissue swelling is the most common manifestation of IPV on head CT scans with frontoparietal region being the most common site. Synchronous and metachronous injuries are frequent.
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Affiliation(s)
- Gaurav V Watane
- From the Department of Radiology, Allegheny General Hospital, Pittsburgh, PA
| | - Anji Tang
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital
| | | | - Hyesun Park
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital
| | - Rahul Gujrathi
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital
| | - Babina Gosangi
- Department of Radiology, Yale New Haven Health, New Haven, CT
| | - Bharti Khurana
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital
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Mikhael V, Ghabi R, Belahmer A, Kadi R, Guirguis N, Gutzeit A, Froehlich JM, Ferreira E, Higgs T, Dufour MM, Theoret V, Hebert M, Turgeon J, Balcom MC, Khurana B, Matoori S. Intimate partner violence: Defining the pharmacist’s role. Can Pharm J (Ott) 2023; 156:63-70. [PMID: 36969310 PMCID: PMC10034523 DOI: 10.1177/17151635231152450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/28/2022] [Indexed: 02/19/2023]
Affiliation(s)
| | | | | | | | | | - Andreas Gutzeit
- Department of Health Sciences and Medicine, University of Lucerne, and the Institute of Radiology and Nuclear Medicine and Breast Center St. Anna
| | - Johannes M. Froehlich
- Hirslanden Klinik St. Anna, Lucerne, Switzerland; the Clinical Research Group, Klus Lab Zurich, Zurich, Switzerland
| | - Ema Ferreira
- Faculté de Pharmacie
- Département de pharmacie, CHU Ste-Justine, Montreal, Quebec
| | | | | | - Valerie Theoret
- Département de sexologie, Université du Québec à Montréal, Montréal, Quebec
| | - Martine Hebert
- Département de sexologie, Université du Québec à Montréal, Montréal, Quebec
| | - Joane Turgeon
- Faculté de l’éducation permanente, Université de Montréal, Montreal, Quebec
| | | | - Bharti Khurana
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
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Imaging and Non-imaging Findings of Intimate Partner Violence on the Trauma Service: A Retrospective Analysis of Two Level 1 Trauma Centers. Acad Radiol 2023; 30:312-321. [PMID: 35597753 DOI: 10.1016/j.acra.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 01/11/2023]
Abstract
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.
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Tang A, Wong A, Khurana B. Update on the Role of Imaging in Detection of Intimate Partner Violence. Radiol Clin North Am 2023; 61:53-63. [DOI: 10.1016/j.rcl.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gosangi B, Wong A, Gujrathi R, Park H, Thomas R, Lewis-O’Connor A, Stoklosa HM, Khurana B. Imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV). Emerg Radiol 2023; 30:71-84. [PMID: 36418488 PMCID: PMC9684831 DOI: 10.1007/s10140-022-02097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/21/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To recognize the imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV). MATERIALS AND METHODS A retrospective radiological review of 688 patients self-reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 30 patients with 89 thoracic injuries. Imaging and demographic data were collected. RESULTS Thirty survivors with 89 injuries to the thorax were identified with a median age of 43.5 years (21-65 years). IPV was reported or disclosed as the direct cause of injury in 50% (15/30) of survivors, including all nine patients who sustained penetrating injuries. The most common injury type was fracture (72%, 64/89) with 52 rib, 3 sternal, 2 clavicular, and 7 vertebral fractures. There were 3 acromioclavicular dislocations. Among rib fractures, right lower anterior rib fractures (9-12 ribs) were the most common(30%, 16/52). There were 10 superficial soft tissue injuries. There were 12 deep tissue injuries which included 2 lung contusions, 2 pneumomediastinum, 7 pneumothoraces, 1 hemothorax. One third of patients had concomitant injuries of other organ systems, most commonly to the head and face, followed by extremities and one third of patients had metachronous injuries. CONCLUSION Acute rib fractures with concomitant injuries to the head, neck, face, and extremities with an unclear mechanism of injury should prompt the radiologist to discuss the possibility of IPV with the ordering physician. ADVANCES IN KNOWLEDGE Recognizing common injuries to the thorax will prompt the radiologists to suspect IPV and discuss it with the clinicians.
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Affiliation(s)
- Babina Gosangi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT USA
| | - Andrew Wong
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Rahul Gujrathi
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hyesun Park
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Richard Thomas
- Department of Radiology, Lahey Health System, Burlington, MA USA
| | - Annie Lewis-O’Connor
- C.A.R.E. Clinic (Coordinated Approach to Resiliency & Empowerment) Founder and Director, Brigham and Womens Hospital, Boston, MA USA
| | - Hanni M. Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA ,Founder and Director, Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
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Giordano V, Giordano C, Lopes IM, Pires RE, Godoy-Santos A, Giannoudis PV. Orthopaedic surgeons can play important role in identifying victims of domestic violence in the emergency department - narrative review of Brazilian literature. Medicine (Baltimore) 2022; 101:e31461. [PMID: 36550911 PMCID: PMC9771306 DOI: 10.1097/md.0000000000031461] [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] [Indexed: 12/24/2022] Open
Abstract
Over the last year, with the social isolation imposed by the coronavirus disease pandemic, there has been a significant increase in complaints associated with physical violence against women. In the present study, an exploratory literature review was carried out on the role of the on-call orthopedic surgeon when faced with a suspicion of domestic violence, in accordance with Brazilian legislation. The main objective of the study was to show the role of this specialist in identifying victims of domestic violence by recognizing their profiles and associated risk factors. The secondary objectives were to demonstrate the most common skeletal and non-skeletal injuries in this type of violence and to present a quick and practical guide on how to identify, approach, and manage cases of domestic violence against women. The findings revealed that the main aggressors were close partners, such as spouses and ex-spouses. Young adult women, black or multiracial, and low socioeconomic status are major risk factors for intimate partner violence. Head and neck injuries are the most frequently observed lesions in this population, with more than one-third of victims reporting falls. Musculoskeletal injuries are present in up to 42% of victims of domestic violence, occurring predominantly in the upper limbs and chest, and are the leading cause of death in women aged 1 to 34 years. A practical guide for orthopedic surgeons who work in emergency departments is proposed, with basic information about their role and responsibility in identifying potential victims of intimate partner violence.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
- Clínica São Vicente, Rede D’or São Luiz, Rio de Janeiro, Brazil
- *Correspondence: Vincenzo Giordano, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, 22430-160, Rio DE Janeiro, RJ, Brazil (e-mail: )
| | - Carolina Giordano
- Clínica da Família Maria do Socorro Silva e Souza, Secretaria Municipal de Saúde do Rio de Janeiro, Clínica da Família Estácio de Sá, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isadora Maria Lopes
- Clínica da Família Maria do Socorro Silva e Souza, Secretaria Municipal de Saúde do Rio de Janeiro, Clínica da Família Estácio de Sá, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Alexandre Godoy-Santos
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Peter V. Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom
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Juszczyk P, Sondern L, Pfleiderer B. Introduction and evaluation of a clinical compulsory elective course on domestic violence. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc56. [PMID: 36540563 PMCID: PMC9733485 DOI: 10.3205/zma001577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 06/17/2023]
Abstract
GOAL Knowledge about domestic violence (DV) in medicine is often lacking, even though health professionals are often the first point of contact for victims of DV. A clinical compulsory elective course for medical students on DV was introduced to increase competences and knowledge on DV. The course is based on the didactic concept of the IMPRODOVA training platform [https://training.improdova.eu/en/] and was first piloted at the Medical School at the University of Muenster in summer 2020. The course was evaluated to assess whether it is suitable to increase knowledge and competences on DV. Accordingly, the following research questions were assessed: What competences and knowledge do students have about DV in general and how do students' competences and knowledge about DV change after participating in the course? METHODS Knowledge assessment on DV in general was based on two surveys conducted at the German universities of Muenster and Luebeck in 2020 and 2021. 54 medical students from Muenster (n=37) and Luebeck (n=17) participated. Muenster medical students were asked to complete a questionnaire within a two-week time period prior participation in the clinical compulsory elective course on DV. Luebeck medical students who had registered for a workshop on DV participated in the same survey prior to the webinar. 28 of the medical students in Muenster underwent in addition a post course assessment. The surveys were created using Questback's online survey research tool EFS using a 5-Point-Likert-Scale. Participation was voluntary and anonymous. The results are reported descriptively and differences between pre- and post-surveys were assessed by t-tests and effect sizes. RESULTS Knowledge assessment indicated that medical students had severe gaps in knowledge related to DV. Completion of an elective course has contributed to a significant learning and competence progress of the students in all DV subject areas. CONCLUSION The newly established course is suitable to increase knowledge and competences on DV in medical students and should be included mandatory into the medical curriculum.
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Affiliation(s)
- Paulina Juszczyk
- University of Muenster, Clinic for Radiology and Medical Faculty, Muenster, Germany
| | - Lisa Sondern
- University of Muenster, Clinic for Radiology and Medical Faculty, Muenster, Germany
| | - Bettina Pfleiderer
- University of Muenster, Clinic for Radiology and Medical Faculty, Muenster, Germany
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14
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Lessons Learned: A Case of Intimate Partner Violence During the COVID-19 Pandemic. Adv Emerg Nurs J 2022; 44:190-198. [PMID: 35900238 DOI: 10.1097/tme.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intimate partner violence (IPV) has been a major public health threat long before COVID-19. However, the pandemic has removed protective measures from victims, while heightening risk factors associated with IPV. Emergency department providers are often the initial point of contact in the health care system for IPV victims; therefore, knowledge of current screening guidelines and best practices in assessment and management of IPV is essential. The purpose of this case report is to present a missed opportunity involving IPV in an emergency department during the COVID-19 pandemic and to discuss the lessons learned with the aim of educating health care providers on the subtle signs of IPV and current screening guidelines.
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15
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Gujrathi R, Tang A, Thomas R, Park H, Gosangi B, Stoklosa HM, Lewis-O’Connor A, Seltzer SE, Boland GW, Rexrode KM, Orgill DP, Khurana B. Facial injury patterns in victims of intimate partner violence. Emerg Radiol 2022; 29:697-707. [PMID: 35505264 PMCID: PMC9064123 DOI: 10.1007/s10140-022-02052-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Rahul Gujrathi
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Anji Tang
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Richard Thomas
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hyesun Park
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Babina Gosangi
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hanni M. Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA USA
| | - Annie Lewis-O’Connor
- C.A.R.E. Clinic (Coordinated Approach to Resiliency & Empowerment), Brigham and Women’s Hospital, Boston, MA USA
| | - Steven E. Seltzer
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Giles W. Boland
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
- Brigham and Women’s Physicians Organization, Boston, USA
| | - Kathryn M. Rexrode
- Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
| | - Dennis P. Orgill
- Department of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
| | - Bharti Khurana
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
- Department of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
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16
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Pierce ME, Fortier C, Fonda JR, Milberg W, McGlinchey R. Intimate Partner Violence Predicts Posttraumatic Stress Disorder Severity Independent of Early Life and Deployment-Related Trauma in Deployed Men and Women Veterans. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:2659-2680. [PMID: 32659158 DOI: 10.1177/0886260520938514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intimate partner violence (IPV) refers to emotional, physical, and/or sexual abuse perpetrated by a current or former partner. IPV affects both genders, though little is known about its effects on men as victims. The aims of this study were to determine if IPV is a factor contributing to posttraumatic stress disorder (PTSD) severity independently of deployment-related trauma, and to determine if there are gender differences in these associations. Participants were 46 female and 471 male post-9/11 veterans. Four sequential regressions were employed to examine the independent contribution of IPV among multiple trauma types on PTSD severity in men and women at two epochs, post-deployment (participants were anchored to deployment-related PTSD symptoms) and current (within the past month). Models were significant for both epochs in men (ps < .001) but not in women (ps > .230). In men, IPV independently predicted PTSD severity in both epochs (β > .093). However, in women, early life trauma (β = .284), but not IPV was a significant and independent predictor for current PTSD. Thus, there are distinct gender differences in how trauma type contributes to PTSD symptom severity. Although the statistical models were not significant in women, we observed similar patterns of results as in men and, in some cases, the β was actually higher in women than in men, suggesting a lack of power in our analyses. More research is clearly needed to follow-up these results; however, our findings indicate that IPV is a contributing factor to PTSD severity in veterans.
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Affiliation(s)
- Meghan E Pierce
- VA Boston Healthcare System, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Catherine Fortier
- VA Boston Healthcare System, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer R Fonda
- VA Boston Healthcare System, MA, USA
- Boston University School of Medicine, MA, USA
| | - William Milberg
- VA Boston Healthcare System, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Regina McGlinchey
- VA Boston Healthcare System, MA, USA
- Harvard Medical School, Boston, MA, USA
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17
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Longitudinal imaging history in early identification of intimate partner violence. Eur Radiol 2021; 32:2824-2836. [PMID: 34797386 DOI: 10.1007/s00330-021-08362-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To describe the imaging findings of intimate partner violence (IPV)-related injury and to evaluate the role of longitudinal imaging review in detecting IPV. METHODS Radiology studies were reviewed in chronological order and IPV-related injuries were recorded among 400 victims of any type of abuse (group 1) and 288 of physical abuse (group 2) from January 2013 to June 2018. The likelihood of IPV was assessed as low/moderate/high based on the review of (1) current and prior anatomically related studies only and (2) longitudinal imaging history consisting of all prior studies. The first radiological study date with moderate/high suspicion was compared to the self-reported date by the victim. RESULTS A total of 135 victims (33.8%) in group 1 and 144 victims (50%) in group 2 demonstrated IPV-related injuries. Musculoskeletal injury was most common (58.2% and 44.5% in groups 1 and 2, respectively; most commonly lower/upper extremity fractures), followed by neurologic injury (20.9% and 32.9% in groups 1 and 2, respectively; most commonly facial injury). With longitudinal imaging history, radiologists were able to identify IPV in 31% of group 1 and 46.5% of group 2 patients. Amongst these patients, earlier identification by radiologists was provided compared to the self-reported date in 62.3% of group 1 (median, 64 months) and in 52.6% of group 2 (median, 69.3 months). CONCLUSIONS Musculoskeletal and neurological injuries were the most common IPV-related injuries. Knowledge of common injuries and longitudinal imaging history may help IPV identification when victims are not forthcoming. KEY POINTS • Musculoskeletal injuries were the most common type of IPV-related injury, followed by neurological injuries. • With longitudinal imaging history, radiologists were able to better raise the suspicion of IPV compared to the selective review of anatomically related studies only. • With longitudinal imaging history, radiologists were able to identify IPV earlier than the self-reported date by a median of 64 months in any type of abuse, and a median of 69.3 months in physical abuse.
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18
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Upper extremity fractures due to intimate partner violence versus accidental causes. Emerg Radiol 2021; 29:89-97. [PMID: 34626284 PMCID: PMC8501321 DOI: 10.1007/s10140-021-01972-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 02/03/2023]
Abstract
Purpose The purpose of this study is to evaluate the prevalence of intimate partner violence (IPV)-related upper extremity fractures (UEF) in women presenting to US emergency departments (ED) and compare their anatomic location to those due to accidental falls or strikes. Methods An Institutional Review Board exempt, retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System’s All Injury Program data from 2005 through 2015 for all UEF sustained in women 15 to 54 years old. Injuries based on reported IPV versus accidental falls or strikes were analyzed accounting for the weighted, stratified nature of the data. Results IPV-related UEF represented 1.7% of all UEF and 27.2% of all IPV fractures. The finger was the most common fracture site in IPV (34.3%) and accidental striking (53.3%) but accounted for only 10% of fall-related UEF. There was a higher proportion of shoulder fractures in IPV (9.2%) compared to accidental falls (7.4%) or strikes (2.9%). The odds of a finger fracture were 4.32 times greater in IPV than falling and of a shoulder fracture were 3.65 greater in IPV than accidental striking (p < 0.0001). Conclusions While the finger is the most common site for IPV UEF, it is also the most common location for accidental striking. A lower proportion of finger fractures in fall and of shoulder/forearm fractures in accidental striking should prompt the radiologist to discuss the possibility of IPV with the ED physician in any woman presenting with a finger fracture due to fall and a shoulder/forearm fracture with a vague history of accidental striking.
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19
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Neck and Back Sprain and Hand Flexor Tendon Repair Are More Common in Victims of Domestic Violence Compared With Patients Who Were Not Victims of Domestic Violence: A Comparative Study of 1,204,596 Patients Using the National Trauma Data Bank. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202109000-00002. [PMID: 34491916 PMCID: PMC8416016 DOI: 10.5435/jaaosglobal-d-21-00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to determine the most common orthopedic diagnoses and procedures among patients who experience domestic violence (DV) and to determine whether these were more common in patients who experienced DV compared with those who did not.
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20
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Thomas R, Dyer GSM, Tornetta Iii P, Park H, Gujrathi R, Gosangi B, Lebovic J, Hassan N, Seltzer SE, Rexrode KM, Boland GW, Harris MB, Khurana B. Upper extremity injuries in the victims of intimate partner violence. Eur Radiol 2021; 31:5713-5720. [PMID: 33459857 PMCID: PMC7812562 DOI: 10.1007/s00330-020-07672-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/01/2020] [Accepted: 12/23/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To recognize most common patterns of upper extremity (UE) injuries in victims of Intimate Partner Violence (IPV). METHODS Radiological review of 308 patients who reported physical IPV at our institution from January 2013 to June 2018, identified 55 patients with 88 unique UE injuries. Demographic data and injury patterns and associations were collected from the electronic medical records. RESULTS The cohort included 49 females and 6 males (age 19-63, mean 38). At the time of injury, IPV was reported in 15/88 (17%) and IPV screening was documented for 22/88 (25%) injuries. There were 46 fractures, 8 dislocations or subluxations, and 34 isolated soft tissue injuries, most commonly involving the hand (56/88). Fractures most commonly involved the fingers (21/46, 46%) and the 5th digit (8/27, 30%). Medial UE fractures (5th digit, 4th digit) constituted 44% of hand and finger fractures (12/27) and 26% of all fractures (12/46). Comminuted and displaced fractures were rare (8/46, 17%). Head and face injuries were the most common concomitant injuries (9/22, 41%) and subsequent injuries (21/61, 35%). Of 12 patients with recurrent UE injuries, 6 had recurrent injuries of the same hand. Five of 6 non-acute fractures (83%) were of the hand. CONCLUSIONS Hand and finger injuries are the most common UE injuries in patients with IPV, with finger being the most common site and medial hand the most common region of fracture. Repeated injuries involving the same site and a combination of medial hand and head or face injuries could indicate IPV. KEY POINTS • Upper extremity injuries in victims of intimate partner violence are most commonly seen in the hand and fingers. • Fingers are the most common site of fracture and the medial hand is the most common region of fracture in the upper extremity in victims of intimate partner violence. • In intimate partner violence victims with upper extremity injuries, concomitant injuries and subsequent injuries are most commonly seen in the head and neck region.
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Affiliation(s)
- Richard Thomas
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - George S M Dyer
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Paul Tornetta Iii
- Department of Orthopedic Surgery, Boston Medical Center, 725 Albany St 4th Floor, Suite 4B, Boston, MA, 02118, USA
| | - Hyesun Park
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Rahul Gujrathi
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Babina Gosangi
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jordan Lebovic
- Department of Orthopedic Surgery, Hospital for Joint Diseases, 301 E 17th St, New York, NY, 10003, USA
| | - Najmo Hassan
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Steven E Seltzer
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Giles W Boland
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Mitchel B Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Bharti Khurana
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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21
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Recognizing Isolated Ulnar Fractures as Potential Markers for Intimate Partner Violence. J Am Coll Radiol 2021; 18:1108-1117. [PMID: 33823142 DOI: 10.1016/j.jacr.2021.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to assess the incidence of intimate partner violence (IPV) in women with isolated ulnar fractures and compare the injury characteristics in victims of IPV with those who sustained the same fractures due to other causes. METHODS Electronic health records from three level I trauma centers were queried to identify a cohort of women, aged 18 to 50, sustaining isolated ulnar fractures from 2005 to 2019. Radiographs were reviewed for fracture location, comminution, and displacement. Demographic data, number of visits to the emergency department, and documentation of IPV were also collected. Patients were stratified into four groups based on clinical chart review: confirmed IPV, possible IPV, not suspected for IPV, and not IPV. Historical imaging analysis for IPV prediction was also performed. RESULTS There were 62 patients, with a mean age of 31 years (IPV: 12 confirmed, 8 possible, 8 suspected not IPV, 34 confirmed not IPV). Comparative analysis with and without suspected cases demonstrated IPV to be associated with nondisplaced fractures (95% versus 43%; P < .001 and 91% versus 44%; P = .012). Confirmed cases were also associated with homelessness (46% versus 0%; P < .001), and the number of documented emergency department visits (median 7.0; interquartile range 2.0-12.8 versus 1.0; interquartile range 1.0-2.0; P < .001). Formal documentation of IPV evaluation was completed in only 14 of 62 (22.5%) patients. Historical imaging analysis predicted IPV in 8 of 12 (75%) confirmed IPV cases. CONCLUSION Up to one-third of adult women sustaining isolated ulnar fractures may be the victims of IPV. Lack of displacement on radiographs, frequent emergency department visits, and homelessness would favor IPV etiology.
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22
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Esopenko C, Meyer J, Wilde EA, Marshall AD, Tate DF, Lin AP, Koerte IK, Werner KB, Dennis EL, Ware AL, de Souza NL, Menefee DS, Dams-O'Connor K, Stein DJ, Bigler ED, Shenton ME, Chiou KS, Postmus JL, Monahan K, Eagan-Johnson B, van Donkelaar P, Merkley TL, Velez C, Hodges CB, Lindsey HM, Johnson P, Irimia A, Spruiell M, Bennett ER, Bridwell A, Zieman G, Hillary FG. A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group. Brain Imaging Behav 2021; 15:475-503. [PMID: 33405096 PMCID: PMC8785101 DOI: 10.1007/s11682-020-00417-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
- Department of Health Informatics, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
| | - Jessica Meyer
- Department of Psychiatry, Summa Health System, Akron, OH, 44304, USA
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Amy D Marshall
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
| | - David F Tate
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Alexander P Lin
- Department of Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, 80336, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kimberly B Werner
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
| | - Emily L Dennis
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Ashley L Ware
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers, The State University of New Jersey, Newark, NJ, 07103, USA
| | | | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, 7501, South Africa
| | - Erin D Bigler
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Martha E Shenton
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
- Departments of Psychiatry and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Veterans Affairs, Boston Healthcare System, Boston, MA, 02130, USA
| | - Kathy S Chiou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Judy L Postmus
- School of Social Work, University of Maryland, Baltimore, USA
| | - Kathleen Monahan
- School of Social Welfare, Stony Brook University, Stony Brook, NY, 11794-8231, USA
| | | | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Carmen Velez
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Cooper B Hodges
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Paula Johnson
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Neuroscience Center, Brigham Young University, Provo, UT, 84602, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
- Denney Research Center Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, 90089, USA
| | - Matthew Spruiell
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Esther R Bennett
- Rutgers University School of Social Work, New Brunswick, NJ, 08901, USA
| | - Ashley Bridwell
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Glynnis Zieman
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
- Social Life and Engineering Sciences Imaging Center, University Park, PA, 16802, USA
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Patch M, Farag YMK, Anderson JC, Perrin N, Kelen G, Campbell JC. United States ED Visits by Adult Women for Nonfatal Intimate Partner Strangulation, 2006 to 2014: Prevalence and Associated Characteristics. J Emerg Nurs 2021; 47:437-448. [PMID: 33744016 DOI: 10.1016/j.jen.2021.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Nonfatal intimate partner strangulation poses significant acute and long-term morbidity risks and also heightens women's risk for future femicide. The lifetime prevalence of nonfatal intimate partner strangulation has been estimated to be approximately 10%, or 11 million women, in the general United States population. Given the potential for significant health risks and serious consequences of strangulation, this study adds to the limited literature by estimating prevalence and describing the associated characteristics of strangulation-related visits among United States ED visits by adult women after intimate partner violence. METHODS Prevalence estimation as well as simple and multivariable logistic regression analyses were completed using data from the Nationwide Emergency Department Sample spanning the years 2006 to 2014. RESULTS The prevalence of strangulation codes was estimated at 1.2% of all intimate partner violence visits. Adjusting for visits, hospital characteristics, and visit year, higher odds of strangulation were noted in younger women, metropolitan hospitals, level I/II trauma centers, and non-Northeast regions. Increases in strangulation events among intimate partner violence-related visits in recent years were also observed. DISCUSSION A relatively low prevalence may reflect an underestimate of true nonfatal intimate partner strangulation visits owing to coding or a very low rate of ED visits for this issue. Higher odds of strangulation among intimate partner violence visits by women in more recent years may be due to increased recognition and documentation by frontline clinicians and coding teams. Continued research is needed to further inform clinical, postcare, and social policy efforts.
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Milner JD, Hartnett DA, DeFroda SF, Blackburn AZ, Cruz AI, Daniels AH. Orthopedic Manifestations of Abuse. Am J Med 2021; 134:306-309. [PMID: 33121957 DOI: 10.1016/j.amjmed.2020.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022]
Abstract
Intimate partner violence and elder abuse are common in the United States but often remain undetected. The incidence of these forms of abuse is difficult to quantify, but those with a history of abuse are at risk of chronic health conditions. Physicians are in a unique position of triaging trauma patients and differentiating unintentional from abusive trauma in patients. Certain orthopedic injuries, in particular, may be related to abuse, which may trigger clinical suspicion and lead to further workup or intervention. By increasing awareness, through physician education and increased screening, earlier detection of abuse may prevent more serious injuries and consequences. Therefore, this review evaluates current literature regarding the orthopedic manifestations of abuse in hopes of increasing physician awareness.
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Affiliation(s)
- John D Milner
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI.
| | - Davis A Hartnett
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - Amy Z Blackburn
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
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Imaging patterns of lower extremity injuries in victims of intimate partner violence (IPV). Emerg Radiol 2021; 28:751-759. [PMID: 33629191 DOI: 10.1007/s10140-021-01914-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the pattern and distribution of lower extremity injuries in victims of intimate partner violence (IPV). MATERIALS AND METHODS A retrospective radiological review of 688 patients reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 88 patients with 154 lower extremity injuries. All lower extremity injuries visible on radiological studies were analyzed. Concomitant, recurrent, and associated injuries were also collected, in addition to the demographic data. RESULTS The injuries consisted of 103 fractures, 46 soft tissue injuries, and 5 dislocations. The foot was the most common site of injury representing 39% (60/154) of total injuries, 48% (49/103) of fractures, 17% (8/46) of soft tissue injuries, and 3 dislocations. The ankle was the second most common site of injury representing 30% (47/154) of total injuries, 20% (21/103) of fractures, and 57% (26/46) of soft tissue injuries. Recurrent injuries of the lower extremity were seen in 30% (26/88) of victims who had 74 recurrent injuries. The most common sites of recurrent injury were the foot and ankle, representing 72% (53/74) of recurrent injuries. CONCLUSION Recurrent injuries of the foot and ankle, synchronous craniofacial injuries, and upper extremity injuries in young women (<35 years) should prompt radiologists to consider IPV.
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Matoori S, Khurana B, Balcom MC, Froehlich JM, Janssen S, Forstner R, King AD, Koh DM, Gutzeit A. Addressing intimate partner violence during the COVID-19 pandemic and beyond: how radiologists can make a difference. Eur Radiol 2021; 31:2126-2131. [PMID: 33021703 PMCID: PMC7537584 DOI: 10.1007/s00330-020-07332-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Simon Matoori
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
- Institute of Radiology and Nuclear Medicine and Cancer Center St. Anna Klinik Luzern, Hirslanden Klinik St. Anna, Lucerne, Switzerland.
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria.
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marta Chadwick Balcom
- Community Health Intervention and Prevention Programs, Brigham and Women's Hospital, Boston, MA, USA
| | - Johannes M Froehlich
- Institute of Radiology and Nuclear Medicine and Cancer Center St. Anna Klinik Luzern, Hirslanden Klinik St. Anna, Lucerne, Switzerland
- Clinical Research Group, Klus Apotheke Zurich, Zurich, Switzerland
| | - Sonja Janssen
- Clinic of Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rosemarie Forstner
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Andreas Gutzeit
- Institute of Radiology and Nuclear Medicine and Cancer Center St. Anna Klinik Luzern, Hirslanden Klinik St. Anna, Lucerne, Switzerland.
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria.
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland.
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Steyn M, Bacci N, Holland S. Patterning of fractures in a case of intimate partner homicide (IPH). J Forensic Sci 2020; 66:766-774. [PMID: 33201522 DOI: 10.1111/1556-4029.14619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
South Africa is a country overwhelmed by crime and violence, with very high incidences of abuse against women and children. It is not often that a case of intimate partner homicide is seen in a forensic anthropological context. Here, we report on such a case where the remains of the victim had been buried for some time. The victim was a middle-aged female, while the suspect was a younger adult male. The deceased had suffered massive, repeated trauma during her lifetime with healed fractures and evidence of soft tissue trauma to virtually all parts of her body. A partly healed rib fracture indicates that the abuse continued until shortly before her death. She ultimately succumbed after suffering trauma to her head and face after reportedly being hit by a brick, evidence of which can be seen as perimortem fractures of the face. It is important for forensic anthropologists to identify specific patterns and report on the presence of healed fractures, as they can raise suspicion as to the possibility of chronic abuse. In this case, the evidence suggests a very long period of extreme and repeated trauma, which were apparently not reported or noticed by family members or the medical fraternity.
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Affiliation(s)
- Maryna Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Nicholas Bacci
- Human Variation and Identification Research Unit, School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Shakeera Holland
- Department of Forensic Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Alessandrino F, Keraliya A, Lebovic J, Mitchell Dyer GS, Harris MB, Tornetta P, Boland GWL, Seltzer SE, Khurana B. Intimate Partner Violence: A Primer for Radiologists to Make the "Invisible" Visible. Radiographics 2020; 40:2080-2097. [PMID: 33006922 DOI: 10.1148/rg.2020200010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Intimate partner violence (IPV) is the physical, sexual, or emotional violence between current or former partners. It is a major public health issue that affects nearly one out of four women. Nonetheless, IPV is greatly underdiagnosed. Imaging has played a significant role in identifying cases of nonaccidental trauma in children, and similarly, it has the potential to enable the identification of injuries resulting from IPV. Radiologists have early access to the radiologic history of such victims and may be the first to diagnose IPV on the basis of the distribution and imaging appearance of the patient's currrent and past injuries. Radiologists must be familiar with the imaging findings that are suggestive of injuries resulting from IPV. Special attention should be given to cases in which there are multiple visits for injury care; coexistent fractures at different stages of healing, which may help differentiate injuries related to IPV from those caused by a stranger; and injuries in defensive locations and target areas such as the face and upper extremities. The authors provide an overview of current methods for diagnosing IPV and define the role of the radiologist in cases of IPV. They also describe a successful diagnostic imaging-based approach for helping to identify IPV, with a specific focus on the associated imaging findings and mechanisms of injuries. In addition, current needs and future perspectives for improving the diagnosis of this hidden epidemic are identified. This information is intended to raise awareness among radiologists, with the ultimate goal of improving the diagnosis of IPV and thus reducing the devastating effects on victims' lives. ©RSNA, 2020.
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Affiliation(s)
- Francesco Alessandrino
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Abhishek Keraliya
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Jordan Lebovic
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - George Sinclair Mitchell Dyer
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Mitchel B Harris
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Paul Tornetta
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Giles W L Boland
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Steven E Seltzer
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Bharti Khurana
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
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Watane GV, Gosangi B, Thomas R, Gujrathi R, Park H, Harris MB, Khurana B. Incidence and characteristics of spinal injuries in the victims of intimate partner violence (IPV). Emerg Radiol 2020; 28:283-289. [PMID: 33000362 PMCID: PMC7527263 DOI: 10.1007/s10140-020-01853-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the incidence and patterns of the spinal injuries in the victims of physical IPV. MATERIALS AND METHODS With institutional review board (IRB) approval, we retrospectively reviewed patients referred to our institution's domestic violence intervention and prevention program with a diagnosis directly related to physical abuse between January 2013 and June 2018. Electronic health records and radiology reports were reviewed for all patients. RESULTS A total of 21/688 (3%) IPV patients with 41 vertebral injuries were identified. The study population comprised of 19/21 (90%) females. Median age of the included patients was 43 years with a range of 21-72 years. All vertebral injuries were AO type A spinal injuries. Upper lumbar spine (L1 and L2) was the most common level of injury followed by upper to mid-thoracic spine. The reported mechanism of the injury was IPV in 8/21 (38.0%), fall in 8/21(38.0%), and incidental in 5/21 (24.0%). Ten out of 21 (48%) patients had concomitant injuries, most commonly to the craniofacial region 5/21 (23%). Psychiatry history was positive in 17/21 (81%), and substance abuse was positive in 15/21 (71%) of the patients. CONCLUSION Incidence of spinal injuries is relatively low in IPV with morphologic AO type A injury being the most common type of injury and the upper lumbar spine being the most common level of injury.
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Affiliation(s)
- Gaurav V Watane
- Division of Emergency Radiology, Department of Radiology, Brigham & Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Babina Gosangi
- Department of Radiology, Yale New Haven Health, New Haven, CT, 06510, USA
| | - Richard Thomas
- Lahey Hospital and Medical Center, 41 Mall road, Burlington, MA, 01805, USA
| | - Rahul Gujrathi
- Division of Emergency Radiology, Department of Radiology, Brigham & Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Hyesun Park
- Division of Emergency Radiology, Department of Radiology, Brigham & Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Mitchel B Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Bharti Khurana
- Division of Emergency Radiology, Department of Radiology, Brigham & Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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30
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Guyatt P, Bzovsky S, Bhandari M, Sprague S. Top 10 Things Every Radiologist Needs to Know About Intimate Partner Violence [Formula: see text]. Can Assoc Radiol J 2020; 72:222-227. [PMID: 32960099 DOI: 10.1177/0846537120956542] [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: 11/17/2022] Open
Abstract
INTRODUCTION Intimate partner violence (IPV) is considered to be the leading cause of nonfatal injury to women worldwide. Moreover, the need for effective training for health care professionals (HCPs) and protocol for addressing IPV in health care contexts are well-documented. This article addresses key questions that radiologists may have related to supporting patients who have experienced IPV. METHODS Peer-reviewed journal articles and other formal reports were located using Google Scholar and PubMed in order to assemble this review. CONCLUSIONS Radiologists are well-equipped to help identify possible instances of IPV if they are aware of the injury patterns commonly associated with IPV. Along with other HCPs, radiologists can also advocate for the implementation of protocols that will guide their responses to victims of IPV within their own health care institution.
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Affiliation(s)
- Paige Guyatt
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Ontario, Canada
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31
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Gosangi B, Park H, Thomas R, Gujrathi R, Bay CP, Raja AS, Seltzer SE, Balcom MC, McDonald ML, Orgill DP, Harris MB, Boland GW, Rexrode K, Khurana B. Exacerbation of Physical Intimate Partner Violence during COVID-19 Pandemic. Radiology 2020; 298:E38-E45. [PMID: 32787700 PMCID: PMC7427119 DOI: 10.1148/radiol.2020202866] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Intimate partner violence (IPV) is a global social and public health problem, but published literature regarding the exacerbation of physical IPV during the coronavirus disease 2019 (COVID-19) pandemic is lacking. Purpose To assess the incidence, patterns, and severity of injuries in IPV victims during the COVID-19 pandemic in 2020 compared with the prior 3 years. Materials and Methods The demographics, clinical presentation, injuries, and radiologic findings of patients reporting physical abuse arising from IPV during the statewide COVID-19 pandemic between March 11 and May 3, 2020, were compared with data from the same period for the past 3 years. Pearson χ2 and Fisher exact tests were used for analysis. Results A total of 26 victims of physical IPV from 2020 (mean age, 37 years ± 13 [standard deviation]; 25 women) were evaluated and compared with 42 victims of physical IPV (mean age, 41 years ± 15; 40 women) from 2017 to 2019. Although the overall number of patients who reported IPV decreased during the pandemic, the incidence of physical IPV was 1.8 times greater (95% CI: 1.1, 3.0; P = .01). The total number of deep injuries was 28 during 2020 versus 16 from 2017 to 2019; the number of deep injuries per victim was 1.1 during 2020 compared with 0.4 from 2017 to 2019 (P < .001). The incidence of high-risk abuse defined by mechanism was two times greater in 2020 (95% CI: 1.2, 4.7; P = .01). Patients who experienced IPV during the COVID-19 pandemic were more likely to be White; 17 (65%) victims in 2020 were White compared with 11 (26%) in the prior years (P = .007). Conclusion There was a higher incidence and severity of physical intimate partner violence (IPV) during the coronavirus disease 2019 (COVID-19) pandemic compared with the prior 3 years. These results suggest that victims of IPV delayed reaching out to health care services until the late stages of the abuse cycle during the COVID-19 pandemic. © RSNA, 2020.
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Affiliation(s)
- Babina Gosangi
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Hyesun Park
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Richard Thomas
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Rahul Gujrathi
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Camden P Bay
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Ali S Raja
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Steven E Seltzer
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Marta Chadwick Balcom
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Meghan L McDonald
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Dennis P Orgill
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Mitchel B Harris
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Giles W Boland
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Kathryn Rexrode
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Bharti Khurana
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
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Intimate partner violence crisis in the COVID-19 pandemic: how can radiologists make a difference? Eur Radiol 2020; 30:6933-6936. [PMID: 32607631 PMCID: PMC7326304 DOI: 10.1007/s00330-020-07043-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022]
Abstract
• 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.
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Khurana B, Seltzer SE, Kohane IS, Boland GW. Making the 'invisible' visible: transforming the detection of intimate partner violence. BMJ Qual Saf 2019; 29:241-244. [PMID: 31748403 DOI: 10.1136/bmjqs-2019-009905] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/01/2019] [Accepted: 11/10/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven E Seltzer
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Isaac S Kohane
- Department of Bioinformatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Giles W Boland
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Affiliation(s)
- Efrén J. Flores
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, Massachusetts MA
| | - Anand K. Narayan
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, Massachusetts MA
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