Clinical Features of Heterosexual Intimate Partner Violence Victims With Escalating Injury Severity

The Ethics of Discharge Planning After Violent Injury

INTRODUCTION

Victims of violence (VoV) are at disproportionate risk for future violence, making consideration of patient safety by Emergency Medicine (EM) physicians and Trauma Surgeons (TS) essential when discharge planning (DP) for VoV. Practice patterns and ethical perspectives in DP for VoV, and their respective scenario- and specialty-specific variations, are unknown.

METHODS

We surveyed 118 EM and 37 TS physicians at a level 1 trauma center. Three clinical scenarios were presented (intimate partner violence, elder abuse, gun violence), each followed by four questions assessing practices and ethical dilemmas in DP. Responses were compared using Chi-Square testing.

RESULTS

Response rate was 51.6%. EM physicians more frequently supported patient autonomy to proceed with a potentially unsafe discharge plan after an episode of Intimate Partner Violence (P = .013) and believed that admission could facilitate change in the victim's social situation after an episode of Elder Abuse (P = .026). TS physicians were more likely to offer social admission, providing additional time to navigate safe discharge planning (P = .003), less likely to see social admission as an inappropriate use of limited resources (P = .030) and less likely to support patient autonomy to proceed with a potentially unsafe discharge (P = .003) after gun-related violence.

CONCLUSION

There appears to exist scenario- and specialty-specific variability in the practice patterns and ethical perspectives of EM and TS physicians when discharge planning for victims of violence. These findings highlight the need for further evaluation of specific factors underlying variability by situation and specialty, and their implications for patient-centered outcomes.

Repeat assault injuries: A scoping review of the incidence and associated risk factors

OBJECTIVE

Individuals who experience assault are at high risk of being re-assaulted. Our objective was to identify reported incidences of re-assault and associated risk factors to better inform prevention strategies.

METHODS

We conducted a scoping review and searched databases (MEDLINE, PsychINFO, CINAHL, Cochrane Reviews, and Scopus) and grey literature. We performed abstract and full-text screening, and abstracted incidence of re-assault and information related to age, sex, socioeconomic status, mental illness, and incarceration.

RESULTS

We included 32 articles. Studies varied based on setting where index assaults were captured (n=18 inpatient only, n=13 emergency department or inpatient, n=1 other). Reported incidences ranged from 0.8% over one month to 62% through the lifetime. Important risk factors identified include young age, low socioeconomic status, racialized groups, history of mental illness or substance use disorder, and history of incarceration.

CONCLUSIONS

Rates of re-assault are high and early intervention is necessary for prevention. We identified notable risk factors that require further in-depth analysis, including sex, gender and age-stratified analyses.

POLICY IMPLICATIONS

Key risk factors identified should inform timely and targeted intervention strategies for prevention.

Intimate partner violence with vaginal insertion of a partial chili pod (Capsicum annuum) : A case report

A case of intimate partner violence (IPV) with vaginal insertion of an irritant foreign body, chili pod of Capsicum annum, in a 36‐year‐old woman. She presented with severe burning sensation in the lower abdomen and vulva. This highlights the unique role of gynecologists in the recognition and treatment of IPV.

Physical Harm Reduction in Domestic Violence: Does Marijuana Make Assaults Safer?

Studies on the effect of marijuana on domestic violence often suffer from endogeneity issues. To examine the effect of marijuana decriminalization and medical marijuana legalization on serious domestic assaults, we conducted a difference-in-differences analysis on a panel dataset on NIBRS-reported assaults in 24 states over the 12 years between 2005 and 2016. Assaults disaggregated according to situation and extent of injury were employed as dependent variables. We found that while the total number of assaults did not change, decriminalization reduced domestic assaults involving serious injuries by 18%. From a harm reduction perspective, these results suggest that while the extensive margin of violence did not change, the intensive margin measured by the seriousness of assaults were substantially affected by decriminalization. This result may be partially explained by reductions in offender alcohol intoxication and weapon-involved assault.