INDICATORS OF ASSAULT-RELATED INJURIES AMONG WOMEN PRESENTING TO THE EMERGENCY DEPARTMENT

Study objective: We sought to determine whether women presenting for t reatment of assault-related injuries at a public hospital emergency de partment differed from those presenting for unintentional injuries wit h regard to a variety of demographic and presentation characteristics, nature and anatomic site of injury, and admission or follow-up treatm ent for injury. Methods: We conducted a random-sample retrospective me dical record review of women aged 15 years and older who presented at either of 2 24-hour public-hospital emergency departments in Auckland, New Zealand. The characteristics of women identified as presenting wi th assault-related injuries on the basis of the record review were com pared with those of women who presented for treatment of unintentional injuries. We also assessed the sensitivity and predictive value of na ture and anatomic site of injury as markers of assault. Results: We re viewed 8,051 records, of which 2,966 (37%) involved an injury at prese ntation. Two hundred sixty patients (9%) were identified as victims of assault. Of those women who presented with assault-related injuries a nd had known assailants, most were likely injured by a partner or form er partner. Women with assault-related injuries were more likely to be younger and of Maori or Pacific Islands origin. They were also more l ikely to present between the hours of 6 PM and 6 AM on Friday, Saturda y, or Sunday and to have a greater history of prior presentations to t he emergency department. Compared with patients who presented with uni ntentional injuries, women with assault-related injuries had a greater likelihood of presenting with contusions (odds ratio, 3.54; 95% confi dence interval, 2.57 to 4.88); ill-defined signs and symptoms (odds ra tio, 3.20; 95% confidence interval, 1.46 to 4.18); fractures of the he ad, spine, or trunk (odds ratio, 2.09; 95% confidence interval, 1.23 t o 3.53); and open wounds (odds ratio, 1.90; 95% confidence interval, 1 .39 to 2.61). Assault-related injuries most commonly involved the head (odds ratio, 12.8; 95% confidence interval, 9.33 to 17.68). Despite t he strength of these associations, however, with regard to nature of i njury the sensitivity and positive predictive value of these indicator s were limited (sensitivity less than or equal to 26.5%, positive pred ictive value less than or equal to 24.3%). The maximum sensitivity for anatomic site as a marker for assault was found for injuries to the h ead (63.7%), but the positive predictive value was still low at 35.7%. Women with assault-related injuries were more likely than women with unintentional injuries to be discharged from the emergency department without referral for follow-up treatment and were more likely to leave the department without referral for follow-up treatment and were more likely to leave the department without completing treatment. Conclusi ons: Women identified as presenting with assault-related injuries diff er from those who present with unintentional injuries in terms of thei r demographic and presentation characteristics, as well as the nature, anatomic site of injury, and follow-up treatment for injuries. Althou gh some of this information has implications for service delivery to a bused women, the use of clinical indicators such as nature and anatomi c site of injury have limited predictive value. Therefore we recommend that health care providers routinely screen patients for assault, par ticularly assault by intimate partners, so that they may respond appro priately by providing better treatment and referral.