Rising Rate of Domestic Violence Among Trauma Patients

September 15, 2015

By Will Boggs MD

NEW YORK - The rates of domestic violence among children and adults presenting to trauma centers increased significantly between 2006 and 2012, according to data from the National Trauma Data Bank.

An estimated 1.5 million women and 800,000 men experience domestic violence annually, but the true prevalence of domestic violence among individuals seen by trauma surgeons and emergency physicians remains unclear.

For their study, online September 9 in JAMA Surgery, Dr. Bellal Joseph from the University of Arizona in Tucson and colleagues used data on 2.9 million trauma cases, including 16,575 patients who experienced domestic violence.

The overall prevalence of domestic violence was 5.7 cases per 1,000 trauma center discharges, they found. Most patients (75.1%) were discharged to their home, and the overall mortality rate was 8.6% among children, 1.2% among adults, and 4.1% among elderly patients.

During the study period, the prevalence of domestic violence among trauma patients increased from 14 to 18.5 cases per 1,000 discharges among children, from 3.2 to 4.5 cases per 1,000 discharges among adults, and remained stable at around 0.9 cases per 1,000 discharges among elderly patients.

For all groups, the most common perpetrator of domestic violence was a relative, most commonly male.

Domestic violence was more common than other traumatic events among black and Hispanic individuals, whereas the reverse was true for white people.

"The increasing prevalence of domestic violence in trauma centers needs to be carefully scrutinized," the researchers conclude. "It appears from the results of our study that there is a lack of proper screening and subsequent reporting of domestic violence, especially among adults and the elderly. Initiation of active screening and preventive measures, robust educational campaigns, and uniform screening strategies in trauma centers might help counter this silent epidemic."

Dr. Sherry Hamby, editor of the journal Psychology of Violence, told Reuters Health by email, "I'm shocked and dismayed that almost twice as many children as adults are being treated for trauma related to domestic violence. I was also surprised by the very high rate of mortality - 1 in 17 patients, including 1 in 12 children, died of their injuries in these data; that is astounding."

"Violence is the most neglected health issue in this country," said Dr. Hamby of the University of the South in Sewanee, Tennessee, who was not involved in the study. "If this were any other cause, we would be mobilizing to address this national epidemic."

"We need to offer more to health care providers," she said. "When health professionals become aware that a patient has been a victim of domestic violence, the next steps need to be as clear as they would be if they tested positive for an infection, anemia, diabetes, or any other disorder."

Dr. Gene Feder from the University of Bristol in the U.K., who has studied domestic violence, said, "Whether or not the prevalence is actually rising, we know it is high in any clinical population. Prevention is a societal challenge, but one in which health care has a role to play in identifying victims and enabling them to access domestic violence advocacy and, further down the line, trauma-informed care to deal with the long term mental health (and in the case of this patient population, physical sequelae of domestic violence)."

"You will miss the majority of cases of domestic violence in a trauma setting if you do not ask (and ask again) about the origins of the injury," he told Reuters Health by email.

"The main takeaway from this study is the importance of conducting a solid assessment to determine whether a patient has experienced domestic violence," agreed Dr. Christine E. Murray from the University of North Carolina at Greensboro, who cofounded See the Triumph, a public awareness campaign about domestic abuse.

"In addition, because of the high rates of violence within the sample, it is critical for all medical professionals to know about community resources in their area that they can use to help connect victims and survivors with supportive services to address their full set of needs related to the violence they've experienced," she told Reuters Health by email.

"There are many reasons why victims of domestic violence in a current abusive relationship may be hesitant to report their abuse to their healthcare providers," Dr. Murray said. "Therefore, physicians should be proactive in looking for indicators of abusive relationship and offering resources, even if someone doesn't initially report abuse."

Dr. Joseph did not respond to a request for comments.

SOURCE: http://bit.ly/1M1vUUj

JAMA Surg 2015.

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