Intimate partner violence screening tools: a systematic review.

CONTEXT

Intimate partner violence (IPV) screening remains controversial. Major medical organizations mandate screening, whereas the U.S. Preventive Services Task Force (USPSTF) cautions that there is insufficient evidence to recommend for or against screening. An effective IPV screening program must include a screening tool with sound psychometric properties. A systematic review was conducted to summarize IPV screening tools tested in healthcare settings, providing a discussion of existing psychometric data and an assessment of study quality.

EVIDENCE ACQUISITION

From the end of 2007 through 2008, three published literature databases were searched from their start through December 2007; this search was augmented with a bibliography search and expert consultation. Eligible studies included English-language publications describing the psychometric testing of an IPV screening tool in a healthcare setting. Study quality was judged using USPSTF criteria for diagnostic studies.

EVIDENCE SYNTHESIS

Of 210 potentially eligible studies, 33 met inclusion criteria. The most studied tools were the Hurt, Insult, Threaten, and Scream (HITS, sensitivity 30%-100%, specificity 86%-99%); the Woman Abuse Screening Tool (WAST, sensitivity 47%, specificity 96%); the Partner Violence Screen (PVS, sensitivity 35%-71%, specificity 80%-94%); and the Abuse Assessment Screen (AAS, sensitivity 93%-94%, specificity 55%-99%). Internal reliability (HITS, WAST); test-retest reliability (AAS); concurrent validity (HITS, WAST); discriminant validity (WAST); and predictive validity (PVS) were also assessed. Overall study quality was fair to good.

CONCLUSIONS

No single IPV screening tool had well-established psychometric properties. Even the most common tools were evaluated in only a small number of studies. Sensitivities and specificities varied widely within and between screening tools. Further testing and validation are critically needed.