Department of Legal and Social Medicine, Hôpital Jean-Verdier, Assistance publique - Hôpitaux de Paris, Bondy, France.
Unité mixte de recherche 8156 Centre national pour la recherche scientifique - Unité 997 Institut national de la santé et de la recherche médicale - Ecole des hautes études en sciences sociales - Université Sorbonne Paris Nord, Institut de Recherche Interdisciplinaire Sur les Enjeux Sociaux, Aubervilliers, France.
JMIR Public Health Surveill. 2024 Sep 27;10:e43563. doi: 10.2196/43563.
Little is known about the functional consequences of violence when directly assessed as a primary outcome, and even less about how consistently these consequences are evaluated in a judicial context. The World Health Organization (WHO) highlighted the importance of a functional approach to health in 2001 with the release of the International Classification of Functioning, Disability, and Health (ICF). In most European countries, forensic physicians assess individuals exposed to violence to evaluate the outcomes of violence, providing certified medical evidence for magistrates' sentencing decisions. This evaluation involves a mix of objective, subjective, and contextual elements, such as reported symptoms of fear, pain, and details of the assault. Quantifying these subjective elements with scales could enhance their interpretation and application in a judicial context.
This study aims to (1) characterize and (2) assess 6 scales measuring subjective elements of functional impairment among individuals exposed to violence.
We conducted a retrospective study that included individuals exposed to violence examined in a French department of forensic medicine over 12 months. A typology of violence encountered in medical settings was built based on the mining of electronic health records and the use of pattern recognition algorithms. The optimal number of violence types was determined using a robust and stable clustering approach, involving sample resampling and a multimetric scheme. Patients were then paired according to their homogeneous profiles, and the intra- and interrater reproducibility of the scales was evaluated.
All pain, fear, and life threat scales were significantly associated with higher functional impairment, suggesting that these measures contribute to the overall assessment of functional impairment. The intra- and interrater reproducibility of scales among similar situations of violence was measured, ranging from mild to good, with coefficients of concordance between 0.46-0.66 and 0.43-0.66, respectively. Individuals reporting intimate partner violence showed higher scores in both fear and perception of a life threat during the assault and medical interview, while individuals reporting battery by multiple unknown assailants presented higher scores only in perception of a life threat during the assault. We identified 5 remarkably stable profiles of situations of violence, consistent with clinical practice.
Pain, fear, and life threat scales were related to functional impairment according to expert knowledge and demonstrated fair reproducibility under real-life conditions for similar situations of violence. Subjective elements related to functional impairment in individuals exposed to violence can be quantified using Likert scales during medical interviews.
当直接作为主要结果进行评估时，人们对暴力的功能后果知之甚少，而在司法环境中如何一致地评估这些后果则知之更少。世界卫生组织（WHO）在 2001 年发布《国际功能、残疾和健康分类》（ICF）时强调了健康的功能方法的重要性。在大多数欧洲国家，法医医生评估接触过暴力的个人，以评估暴力的后果，为治安法官的量刑决定提供有认证的医学证据。这种评估涉及到客观、主观和背景因素的混合，例如报告的恐惧、疼痛症状和袭击的细节。使用量表来量化这些主观因素可以增强它们在司法环境中的解释和应用。
本研究旨在（1）描述和（2）评估 6 种用于评估暴力接触者功能障碍主观因素的量表。
我们进行了一项回顾性研究，该研究纳入了在法国法医部门在 12 个月内接受检查的暴力接触者。根据电子健康记录的挖掘和模式识别算法的使用，构建了医疗环境中遇到的暴力的类型学。使用稳健且稳定的聚类方法确定了最佳的暴力类型数量，该方法涉及样本重新采样和多指标方案。然后根据他们的同质特征对患者进行配对，并评估量表的组内和组间可重复性。
所有疼痛、恐惧和生命威胁量表都与更高的功能障碍显著相关，这表明这些措施有助于对功能障碍的总体评估。在相似的暴力情况下，量表的组内和组间可重复性进行了测量，范围从轻度到良好，一致性系数分别为 0.46-0.66 和 0.43-0.66。报告亲密伴侣暴力的个体在袭击和医疗访谈期间的恐惧和感知生命威胁方面得分较高，而报告被多名不明袭击者殴打者仅在袭击期间的感知生命威胁方面得分较高。我们确定了 5 种非常稳定的暴力情况特征，与临床实践一致。
疼痛、恐惧和生命威胁量表与专家知识相关的功能障碍有关，在真实生活条件下，对相似的暴力情况具有良好的可重复性。在医疗访谈期间，可以使用李克特量表对接触过暴力的个体的功能障碍相关的主观因素进行量化。
