title: Victims of domestic violence on the trauma service: unrecognized and underreported.
abstract: BACKGROUND
  Domestic violence (DV) has received increased recognition as a significant mechanism of injury. To improve awareness about DV at our institution, an educational program was presented to the departments of surgery and emergency medicine. Pre and posttests were given and improvement in knowledge was demonstrated. In addition, a screening question for DV was added to the trauma history and physical (H & P) form. This study was done to determine the long-term efficacy of these efforts in increasing recognition of DV and referral to social services in patients admitted to the trauma service. Recognition of DV and appropriate referral should be increased after education and change in H & P form.
  
  
  METHODS
  All patients admitted to the trauma service at a Level I trauma center over a 10 month period with the mechanism of injury "assault" were reviewed. DV was determined to be present, likely, unknown, or absent based on information from the prehospital report and medical records. The DV screen question was reviewed for use and accuracy.
  
  
  RESULTS
  During the study period, 1,550 patients were admitted to the trauma service, with assault listed as the mechanism of injury for 217 (14%). DV was confirmed or likely in 27 patients (12.4% of the assaults). Of patients with confirmed or likely DV, only 7 received appropriate referrals, with 2 generated by the nursing staff. Of the confirmed and likely DV patients, 17 (63%) were sent home without investigation of safety and only 21% of all assault victims had any social services evaluation (usually to investigate funding or placement). The DV screen was used in only 12 patients. Reasons given for failure to complete the DV screen on the H & P included examiner discomfort in asking the question, and an environment judged to be inappropriate (resuscitation area in the emergency department).
  
  
  CONCLUSIONS
  DV is unrecognized and underreported. Efforts to improve recognition and reporting of DV events need to be ongoing. Screening for DV is not effectively done as part of the initial evaluation. Assessment for DV may be more appropriate as part of the tertiary survey.
authors.affiliation: Trauma Service and Department of Surgery, University Medical Center, Fresno, California 93702, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Davis
authors.forename: Steven N
authors.initials: SN
authors.lastname: Parks
authors.forename: Krista L
authors.initials: KL
authors.lastname: Kaups
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Bennink
authors.forename: John F
authors.initials: JF
authors.lastname: Bilello
mesh_terms: D000328:Adult; D017579:Domestic Violence / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D012017:Referral and Consultation; D012042:Registries; D012947:Social Work / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology