The secrets women keep: intimate partner violence screening in the female trauma patient

Although intimate partner violence (IPV) is the leading cause of serious injury and the second leading cause of death among reproductive age women in America, effective screening is difficult. Our institution currently screens for IPV during the floor intake assessment by having a registered nurse (RN) ask three unscripted questions about physical, verbal, and sexual abuse during a battery of 81 questions. The patients are frequently in pain, medicated, distraught, or intoxicated, and the RN is juggling multiple responsibilities. We also use a protocol-driven alcohol abuse screen on every trauma admission known as "Screening, Brief Intervention, and Referral for Treatment" (SBIRT). It is conducted by trained counselors when any effects of alcohol are gone in a distraction-free setting after patients have had time to ruminate on their admission. We hypothesized that linking the validated partner violence screening (PVS) to SBIRT would result in higher rates of positive IPV screens than after RN screens.

This prospective trial was conducted at an urban Level I center. English- and Spanish-speaking female trauma patients underwent the three-question, nonvalidated RN-screen on floor arrival per the local standard of care. Before discharge, they then underwent SBIRT screening per trauma service protocol, after which SBIRT administered the PVS as our investigative intervention. All screens were native language. SBIRT screeners were blinded to the results of the earlier RN screen. If an SBIRT or RN screen was not performed for any reason, it was categorized as a negative screen. Admissions to the surgical intensive care unit had both screens delayed until floor transfer. McNemar's exact test was used for paired categorical data and Fisher's exact test otherwise. Significance was set at an alpha of 0.05.

One hundred twenty-five consecutive female inpatients (mean age, 40.9 years±17.7 years; Injury Severity Score, 9.8±7.5) were enrolled, with 14 (11.2%) screening positive for one or both methods. The SBIRT-linked screen was significantly better at detecting IPV than the RN screen (p=0.01). No association was found between the likelihood of giving a discordant response to the two IPV screens and acute alcohol intoxication or polysubstance abuse at the time of admission, being a Spanish-only speaker, or if the initial admission was directly to the surgical intensive care unit. Despite being mandatory on intake, 23 of 125 patients (18.4%) had no RN screen performed, with 2 of these patients screening positive for IPV by SBIRT personnel.

Linking an IPV screen to an established alcohol abuse screen results in higher rates of detection of IPV than screening by RNs at intake assessment. At our institution, adoption of this practice should result in detecting and referring ∼85 additional female trauma inpatients per year for IPV services.