Furbee P M, Sikora R, Williams J M, Derk S J
Center for Rural Emergency Medicine, West Virginia University, Morgantown, USA.
Ann Emerg Med. 1998 Apr;31(4):495-501. doi: 10.1016/s0196-0644(98)70260-4.
Previous studies have indicated a number of barriers to screening for domestic violence (DV) in an emergency department setting. These barriers result in inconsistencies which determine who is screened as well as the content and quality of the information obtained, and if uncontrolled they are likely to affect measurements of DV incidence in ED populations. The objectives of this project were to design a screening tool that circumvented these barriers and sources of error; to assess whether such an alternative method of screening for DV was acceptable to our patients; and to determine whether the alternative and traditional methods of screening for DV would yield comparable results. Our hypotheses were that the alternative screening tool would be acceptable to our patients and that no significant differences would be found between the two methods.
The study took place in a rural, university-affiliated ED with approximately 36,000 annual patient visits. The study population consisted of 186 women older than 18 years of age who were treated by one designated physician. Approximately half of these subjects were screened for DV in a face-to-face interview. The other half listened to a tape-recorded questionnaire and recorded their responses on a coded answer sheet.
There were 175 completed screenings. The average age of all respondents was 34 years, and 90 (51%) indicated a cumulative lifetime experience of DV of some sort. Overall, 3% of the respondents indicated they were in the ED for injuries received as a result of DV. No significant differences were found between the two methods of screening for DV on any measurement, including refusals. No problems hearing the tape or understanding the instructions were reported.
These results indicate that the alternative method of employing a recorded questionnaire was no less effective than the best efforts of a designated and conscientious physician. As a means of quickly assessing the prevalence of DV in an ED setting, we find much to recommend such an approach.
以往研究表明，在急诊科环境中对家庭暴力（DV）进行筛查存在诸多障碍。这些障碍导致筛查过程缺乏一致性，进而决定了哪些人接受筛查、所获信息的内容和质量。如果不加以控制，这些障碍可能会影响急诊科人群中DV发生率的测量。本项目的目标是设计一种能够规避这些障碍和误差来源的筛查工具；评估这种DV筛查替代方法对我们的患者是否可接受；并确定DV筛查的替代方法和传统方法是否会产生可比结果。我们的假设是，替代筛查工具对我们的患者是可接受的，并且两种方法之间不会发现显著差异。
该研究在一所与大学相关的农村急诊科进行，每年约有36000人次就诊。研究人群包括186名18岁以上的女性，她们由一名指定医生治疗。其中约一半受试者通过面对面访谈进行DV筛查。另一半则听取录音问卷，并在编码答题纸上记录她们的回答。
共完成了175次筛查。所有受访者的平均年龄为34岁，90人（51%）表示有某种形式的DV累积终生经历。总体而言，3%的受访者表示她们因DV受伤而前来急诊科。在任何测量方面，包括拒绝率，两种DV筛查方法之间均未发现显著差异。没有报告在听录音或理解说明方面存在问题。
这些结果表明，采用录音问卷的替代方法并不比指定且尽责的医生的最大努力效果差。作为在急诊科环境中快速评估DV患病率的一种方法，我们发现这种方法有很多可取之处。
