Characterisation of Victims Of Violence in the A & E Department and Analysis of the Acceptance of a Medico-Legal Expertise Centre After its Implementation vs. Multi-Year Consolidation.

Abstract

People who have become victims of domestic or public violence often suffer long-term physical, psychological and social impairment. Due to physical injury, the first contact with the health care system is frequently an A & E Department. Thus, physicians and especially surgeons play a key role in detecting victims of domestic or public violence. The specific needs of victims are adequate medical treatment of injuries, forensic documentation, as well as interdisciplinary medical support to prevent further morbidity and violence. To take this into account, so-called expertise centres for victims of violence have been established at several locations in Germany in recent years. In this study: I. We tried to define the characteristics of victims of domestic and public violence to ensure better identification by physicians/surgeons. II. We elucidate the acceptance and effectiveness of such an expertise centre one year after its implementation and for a period of three years (2007 - 2009) and for a follow-up period of three years (2014 - 2016) after establishment. Patients were prospectively classified as victims of violence by the attending physician at the A & E Department and further treatment was initiated by the expertise centre for victims of violence. Medical reports from the A & E Department were analysed anonymously and compared with the number of patients of the expertise centre for victims of violence who had been referred from A & E Department. Orthopaedic and trauma surgery is the main referring discipline for the expertise centre for victims of violence. 0.9% of patients (2007 - 2009) and in the follow-up period (2014 - 2016) even 1.6% of patients were identified as victims of violence. However, the acceptance of such a centre fell from 22.2% (2007 - 2009) to 17.2% (2014 - 2016). Physicians and especially trauma surgeons are responsible for identifying victims of domestic or public violence and ensuring further treatment. Accordingly, it is crucial that the expertise centre should characterise the victims of violence and be aware of their different needs, if the expertise centre is to be accepted. The results of this study indicate that interdisciplinary training and close cooperation between traumatology and legal medicine are the main prerequisites for continuous improvement in the treatment of victims of violence.