Fanslow J L, Norton R N, Spinola C G
Family and Intimate Violence Prevention Team, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Ann Emerg Med. 1998 Sep;32(3 Pt 1):341-8. doi: 10.1016/s0196-0644(98)70011-3.
We sought to determine whether women presenting for treatment of assault-related injuries at a public hospital emergency department differed from those presenting for unintentional injuries with regard to a variety of demographic and presentation characteristics, nature and anatomic site of injury, and admission or follow-up treatment for injury.
We conducted a random-sample retrospective medical record review of women aged 15 years and older who presented at either of 2 24-hour public-hospital emergency departments in Auckland, New Zealand. The characteristics of women identified as presenting with assault-related injuries on the basis of the record review were compared with those of women who presented for treatment of unintentional injuries. We also assessed the sensitivity and predictive value of nature and anatomic site of injury as markers of assault.
We reviewed 8,051 records, of which 2,966 (37%) involved an injury at presentation. Two hundred sixty patients (9%) were identified as victims of assault. Of those women who presented with assault-related injuries and had known assailants, most were likely injured by a partner or former partner. Women with assault-related injuries were more likely to be younger and of Maori or Pacific Islands origin. They were also more likely to present between the hours of 6 PM and 6 AM on Friday, Saturday, or Sunday and to have a greater history of prior presentations to the emergency department. Compared with patients who presented with unintentional injuries, women with assault-related injuries had a greater likelihood of presenting with contusions (odds ratio, 3.54; 95% confidence interval, 2.57 to 4.88); ill-defined signs and symptoms (odds ratio, 3.20; 95% confidence interval, 1.95 to 5.24); internal injuries (odds ratio, 2.48; 95% confidence interval, 1.46 to 4.18); fractures of the head, spine, or trunk (odds ratio, 2.09; 95% confidence interval, 1.23 to 3.53); and open wounds (odds ratio, 1.90; 95% confidence interval, 1.39 to 2.61). Assault-related injuries most commonly involved the head (odds ratio, 12.8; 95% confidence interval, 9.33 to 17.68). Despite the strength of these associations, however, with regard to nature of injury the sensitivity and positive predictive value of these indicators were limited (sensitivity < or = 26.5%, positive predictive value < or = 24.3%). The maximum sensitivity for anatomic site as a marker for assault was found for injuries to the head (63.7%), but the positive predictive value was still low at 35.7%. Women with assault-related injuries were more likely than women with unintentional injuries to be discharged from the emergency department without referral for follow-up treatment and were more likely to leave the department without completing treatment.
Women identified as presenting with assault-related injuries differ from those who present with unintentional injuries in terms of their demographic and presentation characteristics, as well as the nature, anatomic site of injury, and follow-up treatment for injuries. Although some of this information has implications for service delivery to abused women, the use of clinical indicators such as nature and anatomic site of injury have limited predictive value. Therefore we recommend that health care providers routinely screen patients for assault, particularly assault by intimate partners, so that they may respond appropriately by providing better treatment and referral.
我们试图确定在公立医院急诊科因与袭击相关的损伤前来治疗的女性，在各种人口统计学和就诊特征、损伤的性质和解剖部位以及损伤的入院或后续治疗方面，是否与因意外伤害前来就诊的女性存在差异。
我们对年龄在15岁及以上、在新西兰奥克兰的两家24小时公立医院急诊科之一就诊的女性进行了随机抽样回顾性病历审查。将根据病历审查确定为因与袭击相关的损伤前来就诊的女性的特征，与因意外伤害前来治疗的女性的特征进行比较。我们还评估了损伤的性质和解剖部位作为袭击标志物的敏感性和预测价值。
我们审查了8051份病历，其中2966份（37%）在就诊时涉及损伤。260名患者（9%）被确定为袭击受害者。在那些因与袭击相关的损伤前来就诊且已知袭击者的女性中，大多数可能是被伴侣或前伴侣伤害。因与袭击相关的损伤前来就诊的女性更可能较年轻，且为毛利人或太平洋岛屿裔。她们也更可能在周五、周六或周日下午6点至上午6点之间就诊，并且此前到急诊科就诊的次数更多。与因意外伤害前来就诊的患者相比，因与袭击相关的损伤前来就诊的女性出现瘀伤的可能性更大（优势比，3.54；95%置信区间，2.57至4.88）；体征和症状不明确（优势比，3.20；95%置信区间，1.95至5.24）；内伤（优势比，2.48；95%置信区间，1.46至4.18）；头部、脊柱或躯干骨折（优势比，2.09；95%置信区间，1.23至3.53）；以及开放性伤口（优势比，1.90；95%置信区间，1.39至2.61）。与袭击相关的损伤最常累及头部（优势比，12.8；95%置信区间，9.33至17.68）。然而，尽管这些关联很强，但就损伤性质而言，这些指标的敏感性和阳性预测价值有限（敏感性≤26.5%，阳性预测价值≤24.3%）。作为袭击标志物，解剖部位的最大敏感性在头部损伤中发现（63.7%），但阳性预测价值仍然较低，为35.7%。与因意外伤害前来就诊的女性相比，因与袭击相关的损伤前来就诊的女性更可能在未被转诊进行后续治疗的情况下从急诊科出院，并且更可能未完成治疗就离开科室。
被确定为因与袭击相关的损伤前来就诊的女性，在人口统计学和就诊特征、损伤的性质、解剖部位以及损伤的后续治疗方面，与因意外伤害前来就诊的女性存在差异。尽管其中一些信息对为受虐女性提供服务有影响，但使用损伤性质和解剖部位等临床指标的预测价值有限。因此，我们建议医疗保健提供者对患者进行常规的袭击筛查，特别是亲密伴侣的袭击，以便他们能够通过提供更好的治疗和转诊做出适当反应。
