Disparities in investigation of physical abuse among trauma patients

Physical abuse is a significant public health issue in the United States, leading to poor health outcomes such as chronic illness, depression, and substance abuse. Research regarding how the medical system addresses physical abuse in the overall adult population is scarce. The objective of this study was to assess disparities in investigation of physical abuse among adult trauma patients.

This is a retrospective analysis of the 2017-2019 American College of Surgeons-Trauma Quality Program database. This study included all adult patients (≥18 years) who had a report of physical abuse by the medical team to authorities. Chi square and multivariate analysis were applied where appropriate to assess which characteristics showed disparities in investigation rate.

On univariate analysis, there were disparities with regard to age, mechanism, race, ethnicity, payment method, and mental health or substance use disorder. On multivariate analysis, male sex, non-penetrating trauma, age ≥70, American Indian race, and presence of a mental health disorder were associated with decreased odds of investigation. Non-elderly adult patients made up a disproportionate amount of abuse victims.

This study shows significant disparities in the escalation of a physical abuse report to an official investigation in the trauma setting. The authors recommend increased advocacy and resource allocation for these vulnerable populations in the clinical setting as well as further research regarding to what extent patient choice versus discretion of authorities influences these disparities. The authors also recommend a larger research focus on non-elderly adult victims of abuse.