New study: Emergency departments may miss 70% of domestic abuse cases

Emergency departments may be missing over 70 percent of domestic abuse cases, warns new study.

Although nearly 80 percent of female victims of intimate partner violence visit emergency departments for medical complaints, as many as 72 percent are not identified as victims of abuse. Of those who are, very few are offered adequate support, according to Dr. Karin Rhodes, from the University of Pennsylvania in the US, and her colleagues. Their work appears online this week in the Journal of General Internal Medicine, published by Springer.

Emergency departments have mandated protocols for intimate partner violence screening and intervention. Rhodes and team assessed how effective the emergency department providers were at identifying cases of domestic abuse, which characteristics of the victim made her more likely to be identified as a victim, and what support was provided when partner violence was identified.

The researchers examined all emergency department visits and intimate partner violence-related police events over a four-year period (1999-2002). The study took place within eight emergency departments, twelve police jurisdictions, and the prosecuting attorney's office, in a semi-rural Midwestern county in the US.

A total of 993 female victims of domestic violence generated 3,246 related police incidents over the four-year period. Approximately 80 percent went to emergency departments after the date of the documented incident. Nearly 80 percent of them came with medical complaints and 72 percent were never identified as victims of abuse, even though, on average, these women visited the emergency department seven times over the study period. Women who had filed a police complaint that day, or been taken to the hospital by the police, those who self-disclosed domestic assault, and those who had mental health and substance abuse issues, were more likely to be identified as victims of intimate partner violence.

When victims were identified, the emergency department response included legally useful documentation 86 percent of the time, police contact 50 percent of the time and a social worker 45 percent of the time. Unfortunately, only 33 percent of the time did providers assess whether the victim had a safe place to go and only 25 percent of identified victims were referred to domestic violence services.

The authors conclude: "Our work shows that the majority of police-identified intimate partner violence victims frequently use the emergency department for health care, but they are unlikely to be identified or receive any intervention in that setting. Current screening practices for intimate partner violence victims are ineffective and policy-driven interventions for identified victims are, at best, erratically implemented."