Interpersonal Violence

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Who to Screen in the ER

  • ideally everyone
  • Institute of Medicine recommends screening women once a year
  • in the ER, screen females with:
  1. reproductive age
  2. signs/symptoms of mental health issues
  3. chronic abdominal pain
  4. any female with any injury
  • especially injuries in a central pattern:
    • head, face, neck, thorax, abdomen

How to Screen

  1. excuse all the family or friends from room
  2. "I'm going to ask a few quick questions that I ask all of my patients and then I will bring you back in the room to help with the care in a few minutes"
  3. "I'm going to ask you some questions that I ask all of my patients because violence against women is such an issue."
  4. "Has anyone hit, kicked, or punched you within the past year?"
  5. If they say yes: "how often?", "have they spoken to anyone about it?", "do they feel unsafe at home because of it?"
  6. you should refer them to social work in house or contact 800-799-SAFE
  7. if you're suspicious, but they do not say anything: "your injuries do not seem to fit the story, can you go through how this happened?"
  8. if still not forthcoming: "here are resources we give all patients as this might be an issue for you or a friend at a later time"
  9. thank them for sharing such difficult information

Mandatory Reporting

  • in California, physicians are required to make a report if they provide medical services to a patient whom they suspect is suffering from a physical injury due to a firearm or assaultive or abusive conduct

See Also: Mandatory Reporting

Who is high risk?

  • anyone with a significant injury
  • threats by their partner to kill them
  • strangulation injuries
  • suicidal partner
  • pregnancy

Disposition

  • refer to social services
  • advise them to keep some money separate, notify a friend, and have an escape plan
  • if they are in imminent danger you may need to admit them

References

Muelleman RL et al. Battered woman: injury locations and types. Ann Emerg Med. 1996 Nov;28(5):486-92. http://www.futureswithoutviolence.org/userfiles/file/HealthCare/mandatory_calif.pdf