Tennakoon Lakshika, Hakes Nicholas A, Knowlton Lisa M, Spain David A
Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University, Stanford, California.
Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University, Stanford, California.
J Surg Res. 2020 Oct;254:206-216. doi: 10.1016/j.jss.2020.03.062. Epub 2020 May 26.
Domestic and intimate partner violence (DV) are under-reported causes of injury. We describe the health care utilization of DV patients, hypothesizing they are at increased risk of mortality.
We queried the 2014 Nationwide Emergency Department Sample for adult patients (18 y and older) with a primary diagnosis of trauma. DV was abstracted using International Statistical Classification of Diseases, ninth Revision codes for partner or spouse intimate violence, abuse, or neglect. The primary outcome was mortality; secondary outcomes included admission rates and charges.
Among 14 million trauma patients, 654,356 (5.0%) had a diagnosis of DV. Compared with other trauma patients, DV patients were younger (34.6 versus 46.8 y, P < 0.001), more often male (69.5% versus 50.1%, P < 0.001), and more likely to be uninsured (31.5% versus 15.6%, P < 0.001). 9154 (1.4%) were injured because of intimate partner violence, of which 90.2% were female. Drug and alcohol abuse (22.2%), anxiety (1.8%), and depression (1.3%) were high among all DV trauma patients. DV emergency department charges were higher ($4462 versus $2,871, P < 0.001). In adjusted analyses, DV trauma patients had 2.1 higher odds of mortality (aOR: 2.31, P < 0.001). DV trauma patients were also associated with a $1516 increase in emergency department charges compared with non-DV trauma patients (95% CI: $1489-$1,542, P < 0.001).
Injuries related to all types of DV are emerging as a public health crisis among both genders. To mitigate under-reporting, it is important to identify at-risk patients and provide them with appropriate resources.
家庭及亲密伴侣暴力（DV）是未被充分报告的受伤原因。我们描述了DV患者的医疗保健利用情况，并假设他们的死亡风险增加。
我们查询了2014年全国急诊科样本中以创伤为主要诊断的成年患者（18岁及以上）。DV是使用国际疾病分类第九版中伴侣或配偶亲密暴力、虐待或忽视的编码提取的。主要结局是死亡率；次要结局包括住院率和费用。
在1400万创伤患者中，654356例（5.0%）被诊断为DV。与其他创伤患者相比，DV患者更年轻（34.6岁对46.8岁，P<0.001），男性比例更高（69.5%对50.1%，P<0.001），且未参保的可能性更大（31.5%对15.6%，P<0.001）。9154例（1.4%）因亲密伴侣暴力受伤，其中90.2%为女性。所有DV创伤患者中药物和酒精滥用（22.2%）、焦虑（1.8%）和抑郁（1.3%）的发生率较高。DV急诊科费用更高（4462美元对2871美元，P<0.001）。在多因素分析中，DV创伤患者的死亡几率高2.1倍（校正比值比：2.31，P<0.001）。与非DV创伤患者相比，DV创伤患者的急诊科费用也增加了1516美元（95%可信区间：1489 - 1542美元，P<0.001）。
各类DV相关伤害正成为男女两性中的公共卫生危机。为减少报告不足，识别高危患者并为其提供适当资源很重要。
