Does Screening in the Emergency Department Hurt or Help Victims of Intimate Partner Violence?
Presented at a panel presentation at the Family Violence Prevention Fund conference, March 2007, San Francisco, CA.
Received 11 May 2007; received in revised form 16 September 2007 and 31 October 2007; accepted 6 November 2007. published online 04 March 2008.
Study objective
Recent systematic reviews have noted a lack of evidence that screening for intimate partner violence does more good than harm. We assess whether patients screened for intimate partner violence on a computer kiosk in the emergency department (ED) experienced any adverse events during or subsequent to the ED visit and whether computer kiosk identification and referral of intimate partner violence in the ED setting resulted in safety behaviors or contact with referrals.
Methods
We conducted a prospective, observational study in which a convenience sample of male and female ED patients triaged to the waiting room who screened positive (on a computer kiosk-based questionnaire) for intimate partner violence in the past year were provided with resources and information and invited to participate in a series of follow-up interviews. At 1-week and 3-month follow-up visits, we assessed intimate partner violence, safety issues, and use of resources. In addition, to obtain an objective measure of safety, we assessed the number of violence-related 911 calls to participant addresses within a call district 6 months before and 6 months after the index ED visit.
Results
Of the 2,134 participants in a relationship in the last year, 548 (25.7%) screened positive for intimate partner violence. No safety issues, such as calling security or a partner’s interference with the screening, occurred during the ED visit for any patient who disclosed intimate partner violence. Of the 216 intimate partner violence victims interviewed in person and 65 contacted by telephone 1 week later, no intimate partner violence victims reported any injuries or increased intimate partner violence resulting from participating in the study. For the sample in the local police district, there was no increase in the number of intimate partner violence victims who called 911 in the 6 months after the ED visit. Finally, 35% (n=131) reported they had contacted community resources during the 3-month follow-up period.
Conclusion
Among patients screening positive for intimate partner violence, there were no identified adverse events related to screening, and many had contacted community resources.
aDepartment of Emergency Medicine, Emory University, Atlanta, GA
bDepartment of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
cDepartment of Epidemiology, State University of New York at Albany, Albany, NY
dDepartment of Psychiatry, University of Rochester, Rochester, NY
eDepartment of Emergency Medicine, Rush Medical College, Chicago, IL
fDepartment of Biostatistics, Emory University, Atlanta, GA
gDepartment of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
Address for correspondence: Debra Houry, MD, MPH, Department of Emergency Medicine, Emory University, 49 Jesse Hill Jr Dr SE #114, Atlanta, GA 30303; 404-616-3181, fax 404-616-6182
Supervising editors: Rita K. Cydulka, MD, MS; Michael L. Callaham, MD
Author contributions: DH, NJK, LAM, CC, HS, and KVR developed the study design and obtained funding. DH, NJK, and RSK oversaw the study protocol and enrollment of participants. ER and CL performed statistical analyses. All authors participated in drafting and revising the article and all approved the final version. DH takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Supported by CDC R-49 grant 4230113 (Houry), NIMH K-23 grant 069375 (Houry), and NIMH K23 64574 (Rhodes).
ABSTRACT