Domestic Violence

As many as 23% of US women experience violence perpetrated against them by an intimate partner, and it is estimated that anywhere from 2-12% of all women evaluated in US emergency departments have injuries related to intimate partner violence (IPV). Additionally, studies suggest that 20% of women killed by their partner have been seen in the ED the year prior for issues related to IPV.  Emergency and trauma physicians thus play a key role in identifying these women and offering them available resources. However, those who have worked in emergency rooms and trauma bays recognize that in the busy, fast-paced environment issues such as IPV may take a backseat to issues of hemodynamic instability, poorly controlled airways, or other medical and surgical emergencies. Additionally, some providers may simply feel uncomfortable addressing issues such as IPV with patients.

To overcome such concerns, numerous groups have worked to arm providers with validated, easy to use instruments to help identify women at risk for intimate partner violence. One group in particular (see citation below) has worked to develop a brief, 5 question instrument designed to accurately identify those IPV victims at the highest risk of severe repeat assault. To do this, researchers conducted an interview of IPV victims that included the Campbell’s Danger Assessment survey, a well validated, 20 question instrument.  Each victim was contacted 9 months following initial presentation to determine whether abuse had occurred since the initial interview. Researchers then analyzed which survey questions were most predictive of a violent, repeat assault. Answering “yes” to three of the five following questions was found to be 83% sensitive and 56% specific for predicting severe repeat assault:

1. Has the physical violence increased in frequency or severity over the past 6 months?

2. Has he ever used a weapon or threatened you with a weapon?

3. Do you believe he is capable of killing you?

4. Have you ever been beaten by him while you were pregnant?

5. Is he violently and constantly jealous of you.

Researchers concluded that these five questions may be utilized to help physicians quickly identify victims of IPV that are at highest risk of repeat, violent assault. 

Intimate partner violence: development of a brief risk assessment for the emergency department. 2009. Snider C, Webster D, O'Sullivan C, Campbell J.  Academic emergency medicine. 16(11): 1208-1216

Thanks to Dr. Erica Carlisle for this post.