Diagnosis Of Domestic Violence Research Articles

Epidemiologic trends of domestic violence–related ocular injuries among pediatric patients: data from the Nationwide Emergency Department Sample 2008-2017

PurposeTo study the epidemiology of all domestic violence (DV)–related ocular injuries among pediatric emergency department (ED) patients in the United States. MethodsThis is a retrospective, cross-sectional study of isolated children (<18 years of age) with a diagnosis of DV and primary or secondary diagnosis of ocular injuries in the Nationwide Emergency Department Sample, 2008-2017. We calculated annual incidence of DV-related ocular injuries and prevalence by demographic variables, including age, sex, and income quartile. Median charges, median length of inpatient hospital stay, and factors associated with hospitalization were also measured. ResultsFrom 2008 to 2017, there were 4,125 ED encounters, with an average incidence of 0.56 per 100,000 population (males, 50.0%; mean age [SE], 9.2 [0.3]). Patients in the lowest income quartile (42.6%) and with Medicaid insurance (63.2%) were the most prevalent. The most common known perpetrator was a family member (29.4%). Most ED encounters took place at southern regional (28.6%), metropolitan teaching (67.1%) and designated trauma hospitals (57.8%). Contusion of the eye/adnexa and being struck by or against an object were the most common ocular diagnosis and known mechanism of injury, respectively. An estimated 12.4% of patients were admitted with a median hospital stay of 4 (IQR, 2-6). Median charges during the study period were $27,415.10 (IQR, $13,142.70-$54,454.90). ConclusionsDV-related ocular injuries were most prevalent among patients with a low socioeconomic status. Given the historical underreporting of DV, future studies are warranted to identify more specific social determinants of health that contribute to such presentations.

Domestic Violence-Related Ocular Injuries Among Adult Patients: Data from the Nationwide Emergency Department Sample, 2008–2017

ABSTRACT Purpose To investigate domestic violence (DV)-related ocular injuries among adult emergency department (ED) patients in the US. Methods This was a retrospective, cross-sectional study of patients with a diagnosis of DV and diagnosis of ocular injury in the Nationwide Emergency Department Sample (NEDS) from 2008–2017. We identified patient- and hospital-level variables associated with DV-related ocular injuries. We calculated annual incidence rates using US Census data. Adjusting for inflation using the Consumer Price Index, we calculated mean and total charges. Results From 2008–2017, there were 26,215 ED visits for ocular injuries related to DV with an average incidence of 1.09 per 100,000 adult population (female patients, 84.5%; mean age [SE], 34.3 [0.2]). DV-related ocular injuries were most prevalent among patients in the lowest income quartile (39.1%) and on Medicaid (37.4%). Most ED visits presented to metropolitan teaching (55.4%), non-trauma (46.7%), and south regional (30.5%) hospitals. The most common ocular injury was contusion of eye/adnexa (61.1%). The hospital admission rate was 5.2% with a mean hospital stay of 2.9 [0.2]. The inflation-adjusted mean cost for medical services was $38,540 [2,310.8] per encounter with an average increase of $2,116 per encounter, annually. The likelihood of hospital admission increased for patients aged ≥60 years old, on Medicare, and with open globes or facial/orbital fractures (all p < .05). Conclusion Contusion of the eye/adnexa was the most common ocular injury among patients with DV-related ED visits. To better facilitate referrals to social services, ophthalmologists should utilize DV screenings, especially towards women and patients of less privileged socioeconomic status.

Domestic violence detection amid the COVID-19 pandemic: the value of the WHO questionnaire in emergency medicine

SummaryBackgroundGender-based violence affects 35–45% of women worldwide, mostly coming from domestic violence. A good screening procedure in clinical practice is useful, but WHO does not advise universal screening, recommending further research.Aim(i) To report the frequency of domestic violence cases among admissions to the Emergency Room of a major Italian Hospital in 2020, including during complete ‘Lockdown’ period; (ii) to document acute and chronic health effects of domestic violence and (iii) to asses usefulness of the WHO screening as a tool for uncovering cases which would otherwise remain hidden.Design and methodsA database containing all the information recorded for each of 19 160 patients in the Emergency Room was constructed by a keyword search (‘violence’, ‘assault’, ‘trauma’) to filter the data and retrieve cases of violence in the period between 1 January and 2 June 2020. The self-administered questionnaire of the WHO Multi-country Study on Women’s Health and Domestic Violence against Women was used in women referred to the emergency room for any cause, excluding trauma.ResultsA recent history of domestic violence was disclosed by 22.67%, after completing the WHO questionnaire. Of those not participating in the survey, diagnosis of domestic violence was only 0.6% (128/19 160).ConclusionPower of detection of domestic violence by the WHO questionnaire is very high, while the frequency of occurrence of these events in this population was considerable. Seemingly, it elicits the responsiveness to the topic of the volunteer interviewees. Its use should be firmly recommended, reasonably, while Covid-19 pandemic is affecting health, rights and response.

Identification and management of domestic violence: A randomized trial

Background: Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. Methods: We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. Results: Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67–2.7). Conclusions: The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.

Head, neck, and facial injuries as markers of domestic violence in women

Purpose: The diagnosis of domestic violence (DV) is difficult because of a lack of clearly defined signs and symptoms. The goal of this study was to confirm and refine the role of head, neck, and face (HNF) injuries as markers of DV. Patients and Methods: A cross-sectional study design and a sample of female trauma patients treated in an inner-city hospital emergency room (Grady Memorial Hospital, Atlanta, GA) were used. The predictor study variable was injury location (HNF or other location). The outcome variable was traumatic origin (DV or other cause). A victim of DV was defined as a patient who gave a history of being injured by her spouse or sexual partner. Other data included age, nature of the injury (blunt or penetrating), and injury severity score (ISS). Descriptive, bivariate, and logistic regression statistical analyses were performed. Results: The sample consisted of 100 injured women, with a mean age of 40 ± 16.3 years and a mean ISS of 3.3 ± 3.0. Thirty-four women were victims of DV. The mean age of the DV victims was 32.5 ± 7.3 years, compared with a mean age of 43.9 ± 18.2 year in the other-causes group ( P = .001). The mean ISS for the DV victims was 3.4 ± 3.0, and the mean ISS for the other-causes group was 3.2 ± 3.0 ( P = .65). DV victims were 7.5 (2.5 < RR < 22.9) times more likely to have HNF injuries than other trauma patients ( P < .001), Age was associated with cause and location of injury. After controlling for age, location remained statistically associated with cause ( P = .0002). Sensitivity and specificity of HNF injuries and DV were 91% and 59%, respectively. Conclusions: The data suggest that although HNF injuries and age were sensitive predictors of DV, they remain poor in their specificity as markers.

Hidden trauma: The mostly missed diagnosis of domestic violence

Domestic violence is an epidemic that rages throughout our society. Despite its overwhelming incidence and prevalence, this abuse goes unrecognized and unaddressed in the majority of health care settings. Nonetheless, battered women expect health care providers to initiate discussions about abuse. Improved awareness through education at all levels and protocols will help interrupt the cycle of intergenerational learned violence. Without intervention, domestic violence is perpetuated and escalates.