P013: Management of intimate partner violence in the emergency department

Abstract

Introduction: Intimate partner violence (IPV) is a serious public health concern with complex medico-legal implications and a wide range of morbidity. While the ED is often the primary access point for these patients, IPV is under-recognized. Our objectives were to describe the characteristics of female IPV patients in the ED and determine the assessment and management patterns of physicians at a tertiary care academic ED. Methods: We conducted a health records review of adult (>18years) female patients seen at a tertiary care hospital ED presenting with evidence of IPV from January to September 2016. A combined search strategy of hospital records and Sexual Assault and Partner Abuse Care Program (SAPACP) patient rosters was used to identify study subjects. Data were collected for patient demographic/presenting characteristics, assault characteristics, and patterns of referral, management and patient disposition/discharge. Descriptive statistics were generated. Results: 100 patients met inclusion criteria with; mean age 35.1, female 100.0%, arrival by ambulance 53.0%, and mean CTAS level of 2.4. Abuse screening was completed at triage only 24.0% of the time. Presenting complaints were varied, with the most common being injury or trauma (32.0%). Most patients were only identified from the SAPACP roster. Patients reported strangulation, a strong predictor of future homicide, in 34.0% of cases. Admission to hospital occurred in 7.0% of cases with 19.0% involving specialist consultation and 7.0% leaving against medical advice or without being seen. Legal interactions including police involvement occurred 72.0% of the time and Childrens Aid Society was involved in 26.0% of cases. The final diagnosis was recorded as IPV or equivalent in only 49.0% of cases; the remainder were discharged with a final diagnosis of injury/trauma (26.0%), sexual assault (6.0%), somatic complaint (6.0%), mental health (8.0%), substance use/abuse (3.0%) or other (2.0%). Conclusion: Our study highlights that IPV is a common and heterogeneous entity with a wide spectrum of presentations and morbidity. Strangulation rates were high and are associated with increased risk of homicide. IPV is currently under-recognized and continues to carry stigma as ER physicians only recorded a discharge diagnosis of IPV or equivalent in half of cases. Educational strategies are required to highlight the importance of IPV to ED staff.