Domestic Abuse in the Emergency Department: Can a Risk Profile Be Defined?

Abstract

Abstract. Objectives:The main purpose of this study was to determine whether any clinical or demographic characteristics could identify adult female patients presenting to the emergency department (ED) with a history of domestic abuse. A second objective was to describe the frequency, types, and severity of this abuse. Methods: This study was a crosssectional survey of 611 women conducted in an academically-affiliated, urban ED. Domestic abuse was described as ''recent'' (within the preceding 12 months) or ''lifetime'' (recent or past). This included emotional, physical, and sexual abuse. Results: Recent (7.9%, n = 48) and lifetime (38%, n = 232) domestic abuse was reported. For recently abused women, violence had been severe (87.5%, n = 42) and was associated with 1) trauma (OR 5.4, 95% CI = 2.6 to 11.6), 2) obstetrical and gynecological syndromes (OR 5.6, 95% CI = 2.4 to 13.2), and 3) psychiatric symptoms and substance use (OR 7.3, 95% CI = 2.4 to 22.0). The sensitivities and positive predictive values of these risk factors individually (<27.1% and <25.0%, respectively) and in aggregate (56.3% and 20.9%, respectively) were low. These indicators predicted only 27 (56.3%) of recently abused women. Lifetime domestic violence was more likely in homeless women (OR 5.8, 95% CI = 2.2 to 15.0), although less likely in immigrants (OR 0.4, 95% CI = 0.3 to 0.7). Conclusions: Clinical presentations and demographic characteristics of women presenting to the ED may not be sensitive or predictive indicators of domestic abuse. In the absence of typical clinical or demographic findings, asking all women in the ED about domestic abuse remains a necessary priority. Key words: domestic violence; screening; physician's role; risk factors; partner abuse. ACADEMIC EMER- GENCY MEDICINE 2001; 8:796-803 I N 1992, the American Medical Association published guidelines recommending that medical providers routinely ask all women direct, specific questions about abuse.1 Subsequently, many national medical associations have developed similar guidelines.2-6 Despite these intentions, these recommendations have been fraught with difficulty and remain largely unrealized. Most physicians in the emergency department (ED), as in most settings, do not routinely ask their patients about domestic abuse.7,8 A recent study showed that fewer than 10% of primary care physicians in California routinely take a history about abuse. 9 In the ED, clinicians may be more likely to ask about abuse in women who present with assault-related inju- 10,11 However, women with acute presentations of domestic abuse often do not present with injuries. 12-14The complexity of routinely inquiring about domestic abuse in medical settings has been described. 10,15 Asking all women about this problem may be unrealistic, screening standards are not uniform, and few studies have evaluated the effectiveness of these efforts. However, several programs have achieved the goal of universal screening. 16 In addition, experts assert, and a small body of evidence suggests, that wome...

Experiences of emergency care by the women exposed to acute physical intimate partner violence from the Finnish perspective

“…Recently abused women who have experienced severe violence are more likely to be identified (Zachary et al, 2001). The women in the present study are thus just the 'tip of the iceberg', representing a select group of women.…”

“…Among women seeking emergency care, physical violence may have been accompanied by psychological and sexual violence (Zachary et al, 2001;Kramer et al, 2004). Studies show that psychological/emotional IPV is as strongly associated with health problems as physical IPV (Kramer et al, 2004;Pico-Alfonso et al, 2006).…”

Interactions Between Victims of Intimate Partner Violence Against Women and the Health Care System

“…Overall, between 2% and 14% of women presenting to the ED are there because of injury or illness caused by IPVAW, and between 5% and 38% have experienced IPVAW in the past year; more recent studies report similar findings (Kramer, Lorenzon, & Mueller, 2004). Injuries from IPVAW are not the only reason that abused women present to the ED, but it is likely that IPVAW victims will later return to the ED with such injuries Muelleman & Liewer, 1998;Zachary, Mulvihill, Burton, & Goldfrank, 2001).…”

Physical and social predictors of partner abuse in women attending general practice: a cross-sectional study

“…4 Can predictive indicators of abuse be developed that would assist clinicians in determining who they should ask? 5 Associations of mental health issues with intimate partner violence have been explored in detail. 6,7 In an earlier study the present authors found that the prevalence of abuse was high and that there was a strong association with depression even after adjustment was made for social indicators associated with depression.…”