Domestic violence encompasses a wide variety of maltreatment, including neglect, abandonment, and emotional, physical, sexual, and verbal abuse. The problem remains a significant healthcare burden throughout the United States, with recent national estimates showing that 1.5 million women and 830,000 men experience domestic violence each year. Data from the United States Department of Health and Human Services also show that four children die each day as a result of child abuse. In addition, about 14% of older adults experience some kind of physical, psychological, and sexual abuse each year.
Trauma surgeons and emergency physicians are often at the forefront of the domestic violence problem. They are among the first who can identify and intervene in these challenging situations. “Recent studies suggest that few trauma surgeons and emergency physicians know the true incidence of this problem,” says Bellal Joseph, MD. To address this research gap, Dr. Joseph and colleagues had a study published in JAMA Surgery that assessed the national prevalence and trends of domestic violence among trauma patients.
For the investigation, the study team retrospectively analyzed prospective data from the National Trauma Data Bank on patients who presented to trauma from 2007 to 2012. Over 6 years, the authors identified trauma patients who experienced domestic violence using several diagnosis codes and stratified patients by age into three groups:
- Children (aged 18 or younger)
- Adults (aged 19 to 54).
- Elderly aged 55 and older).
Researchers identified 16,575 trauma patients who experienced domestic violence and the vast majority of cases involved children (61.7%) and adults (33.2%). The average age of trauma patients who experienced domestic violence was about 16 years, and slightly more than half of cases (50.7%) involved male patients. Head injuries and extremity fractures were the most common injuries among trauma patients. Most patients (75.1%) were discharged home, and the overall mortality rate was 5.9%. “The overall prevalence of domestic violence among trauma patients was 5.7 cases per 1,000 trauma center discharges, with an increasing trend over the years,” says Dr. Joseph.
The prevalence of domestic violence increased among children over the 6-year study period, rising from 14.0 cases per 1,000 trauma center discharges in 2007 to 18.5 case per 1,000 trauma center discharges in 2012. A similar trend was observed in adults, rising from 3.2 cases per 1000 discharges in 2007 to 4.5 cases per 1,000 discharges in 2012. The prevalence of domestic violence remained relatively unchanged for elderly patients, at less than zero cases per 1,000 discharges over the study period (Figure). After conducting a sub-analysis of adults and elderly patients, the research team found that the prevalence of domestic violence increased from 2007 to 2012 in both women and men.
Studies indicate that the U.S. has one of the highest child abuse rates among industrialized countries, and this issue spans socioeconomic, ethnic, religious, and cultural lines and across all levels of education. To counter this problem, all states have mandated that physicians report any incident of child abuse to the appropriate authorities. However, identifying abuse and neglect and linking children to appropriate services has been problematic. “It’s important for trauma surgeons and emergency physicians to intervene early and improve their outreach to troubled families to help reduce these problems in the future,” Dr. Joseph says.
Adult abuse or intimate partner violence (IPV) refers to physical, sexual, and psychological harm incurred from a current or former partner or spouse. In the U.S., current estimates show that 4 to 6 million relationships have a partner that encounters IPV at some point in their adult life, and women appear to susceptible to domestic violence and IPV than men. Many patients presenting to the ED have also been exposed to domestic violence.
The study showed a higher prevalence of IPV among adult women than among adult men. However, while men were less likely to be exposed to IPV, there was an increasing trend of IPV among men over recent years. “Domestic violence is often thought of as an acute problem, but the reality is its repercussions extend far beyond the initial event,” says Dr. Joseph. Early intervention and proper resource allocation for identifying domestic violence and IPV can potentially mitigate the increasing incidence of these events.
Although the study observed no changes in trends regarding elder abuse over the course of study, Dr. Joseph says it is important for clinicians to keep domestic violence in mind when managing this patient group. Several legislative and medical interventions have been implemented, but the authors still did not see any significant decrease in the incidence of abuse among the elderly.
“Overall, our results indicate that there is room for improvement to significantly affect this healthcare problem,” Dr. Joseph says. “We lack proper screening for and reporting of domestic violence. We need to be more proactive with screening and prevention measures. There is also a need for robust educational campaigns and uniform screening strategies in trauma centers to help counter this silent epidemic.”
Readings & Resources (click to view)
Joseph B, Khalil M, Zangbar B, et al. Prevalence of domestic violence among trauma patients. JAMA Surg. 2015 Sep 9 [Epub ahead of print]. Available at: http://archsurg.jamanetwork.com/article.aspx?articleid=2432612.
Davis JW, Kaups KL, Campbell SD, Parks SN. Domestic violence and the trauma surgeon: results of a study on knowledge and education. J Am Coll Surg. 2000;191:347-353.
Louwers EC, Korfage IJ, Affourtit MJ, et al. Effects of systematic screening and detection of child abuse in emergency departments. Pediatrics. 2012;130:457-464.
Halpern LR, Perciaccante VJ, Hayes C, Susarla S, Dodson TB. A protocol to diagnose intimate partner violence in the emergency department. J Trauma. 2006;60:1101-1105.
Abramsky T,Watts CH, Garcia-Moreno C, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women’s health and domestic violence. BMC Public Health. 2011;11:109.