title: Intimate partner violence identification and response: time for a change in strategy.
abstract: BACKGROUND
  While victims of intimate partner violence (IPV) present to health care settings for a variety of complaints; rates and predictors of case identification and intervention are unknown.
  
  
  OBJECTIVE
  Examine emergency department (ED) case finding and response within a known population of abused women.
  
  
  METHODS
  Retrospective longitudinal cohort study.
  
  
  METHODS
  Police-involved female victims of IPV in a semi-rural Midwestern county.
  
  
  METHODS
  We linked police, prosecutor, and medical record data to examine characteristics of ED identification and response from 1999-2002; bivariate analyses and logistic regression analyses accounted for the nesting of subjects' with multiple visits.
  
  
  RESULTS
  IPV victims (N = 993) generated 3,426 IPV-related police incidents (mean 3.61, median 3, range 1-17) over the 4-year study period; 785 (79%) generated 4,306 ED visits (mean 7.17, median 5, range 1-87), which occurred after the date of a documented IPV assault. Only 384 (9%) ED visits occurred within a week of a police-reported IPV incident. IPV identification in the ED was associated with higher violence severity, being childless and underinsured, more police incidents (mean: 4.2 vs 3.3), and more ED visits (mean: 10.6 vs 5.5) over the 4 years. The majority of ED visits occurring after a documented IPV incident were for medical complaints (3,378, 78.4%), and 72% of this cohort were never identified as victims of abuse. IPV identification was associated with the day of a police incident, transportation by police, self-disclosure of "domestic assault," and chart documentation of mental health and substance abuse issues. When IPV was identified, ED staff provided legally useful documentation (86%), police contact (50%), and social worker involvement (45%), but only assessed safety in 33% of the women and referred them to victim services 25% of the time.
  
  
  CONCLUSIONS
  The majority of police-identified IPV victims frequently use the ED for health care, but are unlikely to be identified or receive any intervention in that setting.
authors.affiliation: Department Of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. kvr@sp2.upenn.edu
authors.forename: Karin V
authors.initials: KV
authors.lastname: Rhodes
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Kothari
authors.forename: Melissa
authors.initials: M
authors.lastname: Dichter
authors.forename: Catherine
authors.initials: C
authors.lastname: Cerulli
authors.forename: James
authors.initials: J
authors.lastname: Wiley
authors.forename: Steve
authors.initials: S
authors.lastname: Marcus
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006801:Humans; D035846:Law Enforcement / Q000379:methods*; D008137:Longitudinal Studies; D011930:Reaction Time; D012189:Retrospective Studies; D013179:Spouse Abuse / Q000517:prevention & control* / Q000639:trends*; D014754:Violence / Q000517:prevention & control / Q000639:trends; D055815:Young Adult