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Intimate Partner Violence Prevention2020

Type: New Practice Management Guideline (PMG)
Category: Injury Prevention
Committee Liaison: Patrick B Murphy, MD, MPH, MSc


Team leader(s)

Statement:
Intimate partner violence (IPV) is a serious issue with substantial prevalence in the community and represents a significant factor leading to injury related morbidity and mortality. IPV affects 23% of women and 14% of men in the US. Additionally, 16% of homicide victims and over 40% of female murder victims are killed by an intimate partner (Niolan, et al.). Based on data from the National Intimate Partner and Sexual Violence Survey 1 in 4 women and 1 in 10 men have experienced injury, the need for medical care, or post traumatic stress symptoms as a consequence of IPV.

Unfortunately, these numbers have remained relatively constant since 2010, highlighting the need for better prevention strategies (Miller, et al.). Based on data from an EAST multicenter trial, 1 in 9 trauma patients are at risk for intimate partner and sexual violence. There was also a significant association between IPV and trauma-associated comorbidities such as substance abuse, mental illness, and recidivism (Zakrison, et al.). IPV is a major public health concern and sadly common in the trauma patient population. In the last 10 years there has been relatively no improvement in rates of injury in these patients. As members of the trauma community we are in a unique position to both treat injury related to IPV and to provide early intervention when it is suspected.

Our goal is for these practice management guidelines to serve as a framework for trauma centers and emergency rooms to better identify and provide resources to this patient population; thereby reducing IPV associated morbidity
and mortality.

Proposed PICO Questions:

  • Population: All patients who present as victims with a violent mechanism and/or Ob/Gyn complaints
  • Intervention: Trauma center or ED domestic violence intervention program screening questionnaire
  • Comparator: Usual care
  • Outcomes: Reduction in injury and death related to intimate partner violence through early identification of victims Population: Victims of intimate partner violence
  • Intervention: Trauma center or ED domestic violence intervention program which provides victims access to social services for safety
  • Comparator: Usual care
  • Outcomes: Reduction in re-injury or death related to intimate partner violence, access to safe living situations
  • Population: Female victims of intimate partner violence/sexual assault
  • Intervention: Trauma center or ED domestic violence intervention program with access to gyn services
  • Comparator: Usual care
  • Outcomes: Reduction in morbidity related to STIs, improved/safe access to gynecologic and sexual health services
  • Population: Victims of intimate partner violence
  • Intervention: Trauma center or ED domestic violence intervention program with access to mental health services
  • Comparator: Usual care
  • Outcomes: Reduction in injury and death related to intimate partner violence, improved mental health, reduction in suicide/self-harm

References: 1. Niolan, P.H., Kearns, M., Dills, J., Rambo, K., Irving, S., Armstead, T.L., Gilbert, L. (2017). Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices. Atlanta, GA: National Center for Injury Prevention and Control Centers for Disease Control and Prevention 2. Miller, E., McCaw, B. (2019). Intimate Partner Violence. N Engl J Med, 380: 850-857. 3. Zakrison, T. L., Ruiz, X., Gelbard, R., Cline, J., Turay, D., Luo-Owen, X., Namias, N., Crandall, M., George, J., Williams, B. H. (2017). J Trauma Acute Care Surg, 83(1): 105-110.

Team members:
• Randi Smith, MD, MPH
• Hassan Mashbari, MD
• Courtney Edwards, DNP, MPH, RN
• Anna Liveris, MD
• Thomas J. Cartolano, DO
• Nathan Polite, DO, FACOS
• Charles Grigsby, MD
• Rishi Rattan, MD FACS


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