Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA.
Acad Emerg Med. 2012 Oct;19(10):1158-65. doi: 10.1111/j.1553-2712.2012.01449.x. Epub 2012 Sep 25.
Torture has been documented in 132 countries, and approximately 400,000 survivors of torture reside in the United States. It is unknown if torture survivors seek medical care in emergency departments (EDs). The authors set out to estimate the prevalence of survivors of torture presenting to an urban ED.
A cross-sectional survey of ED patients was performed by convenience sampling from October 2008 to September 2009 in a large urban teaching hospital in New York City. ED patients not of a vulnerable population were consented and entered into the study. Participants were asked two screening questions to ascertain if they were self-reported survivors of torture. For exploratory purposes only, these individuals were further queried about their experiences. The detailed responses of these self-reported survivors of torture were compared to the United Nations Convention Against Torture (UNCAT) definition by a blinded, independent panel.
Of 470 study participants, 54 individuals (11.5%, 95% confidence interval [CI] = 8.6% to 14.4%) self-reported torture. Nine (16.7%) had ongoing physical disabilities, 30 (55.6%) had recurrent intrusive and distressing memories, 42 (77.8%) never had a physician inquire about torture, and only eight (14.8%) had requested political asylum. Of these self-reported survivors of torture, 29 (53.7%) met the UNCAT definition, for an adjudicated prevalence of 6.2% (95% CI = 4.3% to 8.7%).
Self-reported survivors of torture presented to this urban ED, and a significant proportion of them met the UNCAT definition of a torture survivor. Continuing torture-related medical and psychological sequelae were identified, yet there was a low rate of asylum-seeking. Only a minority were previously identified by a physician. These data suggest an unrecognized public health concern and an opportunity for emergency physicians to intervene and refer survivors of torture to existing community resources.
酷刑已在 132 个国家得到证实，大约有 40 万名酷刑幸存者留居在美国。目前尚不清楚酷刑幸存者是否会前往急诊部（ED）寻求医疗护理。作者旨在估计前往城市急诊部就诊的酷刑幸存者的患病率。
2008 年 10 月至 2009 年 9 月，作者采用便利抽样法，在纽约市一家大型城市教学医院对急诊部患者进行了横断面调查。未纳入弱势群体的急诊部患者同意并参与了研究。研究人员通过两项筛选问题来确定他们是否为自我报告的酷刑幸存者。仅出于探索性目的，这些人还被进一步询问了他们的经历。对这些自我报告的酷刑幸存者的详细答复与联合国《禁止酷刑公约》（UNCAT）的定义进行了比较，由一个盲法、独立的专家组进行比较。
在 470 名研究参与者中，有 54 人（11.5%，95%置信区间[CI] = 8.6%至 14.4%）自我报告曾遭受酷刑。9 人（16.7%）存在持续性身体残疾，30 人（55.6%）存在反复出现的侵入性和痛苦记忆，42 人（77.8%）从未有医生询问过有关酷刑的问题，仅有 8 人（14.8%）曾请求政治庇护。在这些自我报告的酷刑幸存者中，有 29 人（53.7%）符合 UNCAT 定义，经裁定的患病率为 6.2%（95% CI = 4.3%至 8.7%）。
自我报告的酷刑幸存者前往这家城市急诊部就诊，其中相当一部分人符合 UNCAT 对酷刑幸存者的定义。研究发现，他们仍存在与酷刑相关的持续医疗和心理后遗症，但寻求庇护的比例较低。仅有少数人之前曾被医生识别出来。这些数据表明存在一个未被认识到的公共卫生问题，为急诊医师提供了一个干预和将酷刑幸存者转介给现有社区资源的机会。
