Orthopedic encounters could play key role in early detection of intimate partner violence

A study by researchers at Mass General Brigham highlights the opportunity for orthopedic surgeons to play a critical role in identifying patients who have experienced intimate partner violence (IPV). While orthopedic surgeons are experts in musculoskeletal injuries, screening patients to identify IPV is not routine. This is highlighted by the findings that only 0.3% of referrals for IPV from orthopedic surgeons compared to 29% from the emergency department. Correcting misperceptions about the prevalence of IPV, improving education about IPV-related injuries, and strengthening connections with domestic violence programs and resources could help improve referrals and recognition, according to the authors. Findings are published in JB&JS Open Access.

This study challenges the assumption that orthopedic encounters are not the right place for IPV screening."

Ophelie Lavoie-Gagne, MD, lead author, resident physician, Department of Orthopaedic Surgery, Mass General Brigham

Lavoie-Gagne notes that each member of the orthopedic care team was important in identifying patients experiencing IPV, with patients forming trusting relationships with nurses, surgical trainees, advanced practice providers, and surgeons.

"We have a unique opportunity to educate and empower our patients who otherwise are not presenting for care in other medical sites," said Lavoie-Gagne. "This study underscores the urgent need for tools that combine our clinical expertise with support to provide timely, life-saving referrals. Identifying risk early could alleviate suffering and could also prevent a patient's death."

Investigators analyzed Massachusetts General Hospital (MGH) and Brigham and Women's Hospital (BWH) Domestic Abuse Intervention Programs (DAIP) registry data from 2000 to 2024, categorizing IPV referrals by department and provider specialty. They then reviewed electronic health records for patients referred specifically by orthopedics to assess case characteristics. Among the 11,227 patients referred to DAIPs at MGH and BWH, 29.3% were referred from the emergency department, 18.2% from behavioral health, 8.4% from obstetrics and gynecology, and only 0.3% from orthopedic surgery.

Of the patients referred by orthopedics, many patients had not seen specialists in any other areas in the six months before disclosure, indicating orthopedic surgery teams were the only clinical providers with the opportunity to refer them to intervention programs. More than half of the patients presented to orthopedic surgery for elective care, highlighting how IPV appears even in routine encounters and orthopaedic clinics remain high-yield, high-impact sites for IPV detection.

Investigators note that orthopedic surgeons have unique strengths that position them well to screen for IPV, including their expertise in injury patterns, longitudinal patient relationships, and familiarity with pain management. They also highlight that artificial intelligence models may help identify signs of IPV and could be integrated into orthopedic screening protocols.

""This study reinforces why tools like the Automated Intimate Partner Violence Risk Support System are urgently needed," said senior author Bharti Khurana, MD, MBA, founding director of the Trauma Imaging Research and Innovation Center and an emergency radiologist in the Mass General Brigham Department of Radiology. "Orthopedic encounters often represent missed opportunities to identify patients experiencing IPV. By combining clinicians' expertise with AI models that detect subtle patterns across imaging and clinical data, we can support surgeons in making timely, life-saving referrals."