CHICAGO — Radiologists should be alert to injuries in women and men that are consistent with patterns of intimate partner abuse, researchers said here.
A review of electronic health records referred to domestic abuse and sexual assault programs from January to October 2016 showed that the majority of the 87 intimate partner violence victims seen were female (95%) and African American (40%), with a mean age of 34.7, reported Elizabeth George, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues.
A total of 665 radiology exams were performed in this population over 5 years. The most commonly performed exam was chest x-ray, followed by obstetric ultrasound and musculoskeletal x-rays, they reported at the Radiological Society of North America annual meeting.
“There should be screening programs … to detect intimate partner abuse, even when the patient is not complaining about that abuse when they come into the emergency department [ED],” George said. Also, “radiologists should be made aware of these injuries and be able to detect them.”
George said that about half the people who come to the ED say they have been a victim of emotional, sexual, or physical abuse, while at least 40% of these patients are discovered to have a history of abuse even though they are seeking treatment for an unrelated condition.
While radiologists have been in the forefront in detecting injuries typical of child abuse, “Detection of intimate partner abuse is not part of our training at all. So there are really very few of us radiologists who even think about domestic abuse at all,” George told MedPage Today.
“There is plenty of evidence in the images that we read that tell us there is domestic violence. Many of these patients have new and old fractures, indicating a long-term exposure to violence,” she explained. “As radiologists we have access to current as well as previous imaging, whereas the patient might see a different [ED] physician. We have access to these images, so if we pay attention to the types of injuries, we can see if they have occurred previously and we can put the pieces together.”
The authors also reported that 35 sexual assault victims in the study were younger (mean age 27.3) and that there were fewer traumatic injuries in this population. Intimate partner violence victims were more likely to be homeless, while the sexual assault victims were more likely to use illicit drugs, they noted.
“On the radiologic front, we identified common patterns of injury such as soft tissue injuries and extremity fractures, which often involved the distal upper extremities, suggesting injury from defensive attempts,” George said. “Other commonly seen injuries were facial fractures, which represent an easily accessible area for inflicting trauma. These injury patterns could alert the radiologists to potential intimate partner violence.”
She pointed out that “Many of these patients came to the ED with symptoms unrelated to domestic abuse. We detected that these patients were victims of domestic violence because we do have a screening program at our hospital.”
Max Wintermark, MD, of Stanford University in Stanford, California agreed that radiologists have played a key role in “observing abuse in pediatric patients in the setting of non-accidental trauma. Our role is to raise a flag with the clinician so that instead of discharging the patient, the clinician asks a few more questions.”
But Wintermark, who was not involved in the study, also noted that “the same flags we see in children are not necessarily brought up to the clinicians when if comes to domestic abuse of adults. The first step in addressing this issue is to increase awareness, and that is what these authors have done. It is a very important contribution.”
George and Wintermark disclosed no relevant relationship with industry.