Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, USA.
Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
J Neurotrauma. 2021 Aug 15;38(16):2301-2310. doi: 10.1089/neu.2021.0022. Epub 2021 May 18.
Domestic violence (DV) is a chronic societal epidemic that often involves physical assault to the head, neck, and face, which increases the risk of traumatic brain injuries (TBIs) in DV victims. However, epidemiological data on the extent of TBI-DV at the population scale remain sparse. We performed a statewide, multi-institution, retrospective review of all medical records for patients diagnosed with a concussion, the most common type of TBI, at health care facilities in Arizona, USA, that were licensed by Arizona Department of Health Services (ADHS) during 2016-2018. De-identified records were extracted from discharge data reported to ADHS, which we decoded and transformed to spatiotemporal demographic data of patients who were diagnosed with concussion concurrent with DV. Among 72,307 concussion diagnoses, 940 were concurrent with DV. Sixteen patients died as a result of TBI-DV injuries, where TBI is defined as concussion. Although females were most of the TBI-DV diagnoses, median ages for males and females were 1 and 32 years, respectively, demonstrating that males were predominantly child abuse victims. Whites and Hispanics were victims most diagnosed with concussion and DV, but Native Americans and Blacks comprised a much greater proportion of diagnoses compared with the representative state demographics. Although likely underreported, approximately half of the cases were inflicted by intimate partners, which corresponded closely to marital status. Surprisingly, 61% of victims sought medical treatment for non-concussion injuries and then concussion was entered as a primary diagnosis. The demographic and health care facility disparities demand TBI/concussion screening in suspected DV patients, education and training of care providers, and potential redistribution of resources to select health care facilities.
家庭暴力（DV）是一种慢性社会流行病，通常涉及对头部、颈部和面部的人身攻击，这增加了 DV 受害者创伤性脑损伤（TBI）的风险。然而，在人群规模上，关于 TBI-DV 程度的流行病学数据仍然很少。我们对美国亚利桑那州的所有医疗记录进行了全州范围的多机构回顾性研究，这些记录来自在 2016 年至 2018 年期间获得亚利桑那州卫生服务部（ADHS）许可的医疗保健机构中被诊断患有脑震荡（TBI 最常见的类型）的患者。从 ADHS 报告的出院数据中提取了去识别记录，我们对这些记录进行解码并转换为同时患有脑震荡和 DV 的患者的时空人口统计学数据。在 72307 例脑震荡诊断中，有 940 例与 DV 同时发生。有 16 名患者因 TBI-DV 受伤而死亡，其中 TBI 定义为脑震荡。尽管女性是大多数 TBI-DV 诊断，但男性和女性的中位数年龄分别为 1 岁和 32 岁，这表明男性主要是儿童虐待的受害者。白人女性和西班牙裔是最常见的脑震荡和 DV 诊断患者，但与代表性州人口统计数据相比，美国原住民和黑人占诊断比例要大得多。尽管可能报告不足，但大约一半的病例是由亲密伴侣造成的，这与婚姻状况密切相关。令人惊讶的是，61%的受害者因非脑震荡伤害寻求医疗治疗，然后将脑震荡作为主要诊断。人口统计和医疗保健机构的差异要求对疑似 DV 患者进行 TBI/脑震荡筛查，对护理人员进行教育和培训，并可能将资源重新分配到选定的医疗保健机构。
