Failure of intimate partner violence screening among patients with substance use disorders.
OBJECTIVE
This study examined the relationship between substance use disorder (SUD) and intimate partner violence (IPV) screening and management practices in the emergency department (ED).


METHODS
This was a retrospective cohort study of adult ED patients presenting to an urban, tertiary care teaching hospital over a 4-month period. An automated electronic data abstraction process identified consecutive patients and retrieved visit characteristics, including results of three violence screening questions, demographic data, triage acuity, time of visit, and International Classifications of Disease, 9th revision (ICD-9), diagnosis codes. Data on management were collected using a standardized abstraction tool by two reviewers masked to the study question. Multivariate logistic regression was used to determine predictors of screening and management.


RESULTS
In 10,071 visits, 6,563 violence screens were completed. IPV screening was documented in 33.5% of patients with alcohol-related diagnoses (95% confidence interval [CI] = 27.7% to 39.3%, chi(2) = 116.78, p < 0.001) and 53.3% of patients with drug-related diagnoses (95% CI = 44.3% to 62.3%, chi(2) = 7.69, p = 0.006), compared to 66.1% of patients without these diagnoses (95% CI = 65.2% to 67.1%). In the multivariate analysis, alcohol (odds ratio [OR] = 0.30, 95% CI = 0.22 to 0.40) and drug use (OR = 0.56, 95% CI = 0.38 to 0.83) were associated with decreased odds of screening. Of completed screens, 429 (6.5%) were positive, but violence was addressed further in only 55.7% of patients. Substance abuse did not appear to affect the odds of having positive screens addressed further by providers (OR = 1.96, 95% CI = 0.39 to 10.14).


CONCLUSIONS
This study found an association between SUD and decreased odds of IPV screening. Failure to screen for IPV in the setting of substance use may represent a missed opportunity to address a critical health issue and be a barrier to successful intervention.
Choo
Esther K
EK
Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI, USA. Esther_Choo@brown.edu
Nicolaidis
Christina
C
Jenkinson
Robert H
RH
Cox
Jessi M
JM
McConnell
K John
KJ
D000328:Adult; D004636:Emergency Service, Hospital; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D008875:Middle Aged; D012189:Retrospective Studies; D013179:Spouse Abuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult