Larkin G L, Hyman K B, Mathias S R, D'Amico F, MacLeod B A
Department of Emergency Medicine, Mercy Hospital of Pittsburgh, Duquesne University, PA, USA.
Ann Emerg Med. 1999 Jun;33(6):669-75. doi: 10.1016/s0196-0644(99)70196-4.
Screening for intimate partner violence has been widely advocated in the health care setting, but efforts to assess effectiveness and ensure adequacy of universal screening are largely untested. We sought to identify barriers to screening of female emergency department patients for intimate partner violence during the first year of implementation of a screening protocol.
A retrospective, structured medical chart review of 1,638 randomly identified visits included demographic factors of age, race, marital status, employment status, insurance status, arrival mode, mechanism of presenting complaint, severity of condition, presentation time, and nurse gender. The study was conducted an an inner-city Level I trauma center with 43,000 annual ED visits and universal procedures for screening for intimate partner violence in place since February 1994. The participants were a cohort of 1,509 female patients, 18 years of age or older, who were discharged from the ED between July 1994 and June 1995. The main outcome measure was the odds of being screened as a function of patient and provider variables. Statistical analyses involved univariate and multivariate logistic regression on screening rates (Yes/No) as derived from universal screening instrument variables.
Of 1,638 records reviewed, 483 patients (29.5%) were screened for intimate partner violence. Univariate analyses revealed that women presenting with nonpsychiatric, less acute complaints and those who presented during daylight hours were more likely to be screened than women who presented with psychiatric or more acute complaints, or during the night shift. Male and female nurse providers were equally likely to screen for intimate partner violence. Step-down multivariate analyses agreed with these findings.
In this random sample of female patients, screening rates varied by severity of the patient's condition, type of presenting complaint, and presentation time.
在医疗环境中，对亲密伴侣暴力进行筛查已得到广泛提倡，但评估其有效性以及确保全面筛查充分性的工作在很大程度上尚未得到检验。我们试图确定在实施一项筛查方案的第一年里，对女性急诊科患者进行亲密伴侣暴力筛查存在的障碍。
对1638例随机抽取的就诊病例进行回顾性、结构化病历审查，审查内容包括年龄、种族、婚姻状况、就业状况、保险状况、就诊方式、主诉机制、病情严重程度、就诊时间和护士性别等人口统计学因素。该研究在一家市中心的一级创伤中心进行，该中心每年有43000例急诊科就诊病例，自1994年2月起就有针对亲密伴侣暴力的全面筛查程序。研究对象为1994年7月至1995年6月间从急诊科出院的1509例18岁及以上的女性患者。主要结局指标是根据患者和医护人员变量进行筛查的几率。统计分析涉及对全面筛查工具变量得出的筛查率（是/否）进行单变量和多变量逻辑回归分析。
在审查的1638份记录中，有483例患者（29.5%）接受了亲密伴侣暴力筛查。单变量分析显示，与出现精神疾病或更急性症状的女性患者，或在夜班就诊的女性患者相比，出现非精神疾病、不太急性症状的女性患者以及在白天就诊的女性患者更有可能接受筛查。男性和女性护士进行亲密伴侣暴力筛查的可能性相同。逐步多变量分析与这些结果一致。
在这个女性患者随机样本中，筛查率因患者病情严重程度、主诉类型和就诊时间而异。
