• Horrifying news about domestic violence

      08/19/2013
      Aaron Carroll

    Remember when people got really upset because the ACA was going to pay doctors to ask patients intrusive questions about domestic violence? This is why. “Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a multinational prevalence study“:

    Background

    Intimate partner violence (IPV) is the leading cause of non-fatal injury to women worldwide. Musculoskeletal injuries, which are often seen by orthopaedic surgeons, are the second most common manifestation of IPV. We aimed to establish the 12-month and lifetime prevalence of IPV in women presenting to orthopaedic fracture clinics.

    Methods

    The PRAISE team of 80 investigators did a cross-sectional study of a consecutive sample of 2945 female participants at 12 orthopaedic fracture clinics in Canada, the USA, the Netherlands, Denmark, and India. Participants who met the eligibility criteria anonymously answered direct questions about physical, emotional, and sexual IPV, and completed two previously developed questionnaires (Women Abuse Screening Tool [WAST] and Partner Violence Screen [PVS]). We did a multivariable logistic regression analysis to investigate the risk factors associated with IPV.

    Lots of researchers in five countries asked thousands of women who were evaluated for fractures if they had been abused. The results are horrifying. One in six women who went to an orthopedic clinic reported that they had been the victims of intimate partner violence in the last year. One in three reported being victims at some point in their lives.

    Just sit and think about that for a second. One in three women who were concerned about a fracture had been abused in a relationship at some point.

    Relatively few of the women were going to the clinic for concerns that linked directly to the IPV. That’s why we need to ask everyone, even if they don’t tell a story indicative of abuse. If you read the whole study, though, only 8% of the women in Canada and the US had ever been asked by another health care professional if they had been a victim of abuse. But 81% of women in those countries thought health care professionals in general should ask all women about intimate partner violence.

    Get 81% of people in this country to agree about anything, and you’d have a tough time. This should be one of the least controversial provisions of the ACA.

    @aaronecarroll

     
      Health Policy
      domestic violence, fractures, IPV, screening
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    • by Ryan on August 19th, 2013 at 15:00

      “One in three women who were concerned about a fracture had been abused in a relationship at some point.”

      This is sort of meaningless, unless you can tell us about the population this generalizes too- women who were concerned about a fracture. How large is that population and by design it will include those who are at greater risk, by only looking at an injured populatoin.

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      • by Aaron Carroll on August 19th, 2013 at 15:05

        Take the two seconds to click through to the link I purposely posted. They were all women seen at orthopedic fracture clinics.

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    • by Ryan on August 20th, 2013 at 10:52

      Yes, I understand that. But women going to orthopedic clinics for fractures does not represent the population of all women, or population of all women in america.

      My question is- how does this finding generalize to the population at large? Who does this sample actually represent? For instance, it cannot be concluded that 1 in 6 women in the USA are victims of abuse.

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      • by Aaron Carroll on August 20th, 2013 at 11:16

        From the study (emphasis mine):

        The results of the PRAISE study show that one in six women presenting to orthopaedic clinics have a history of abuse in the past year, and that one in 50 attend their appointment as a direct consequence of IPV. These findings are similar to those of a recent meta-analysis of 37 studies in which the prevalence of IPV in patients presenting to different medical specialties was investigated, with the best estimates of the lifetime prevalence of any type of IPV being 40% in family medicine and 38% in emergency medicine (panel).6 Arguably, the severity of physical abuse in women presenting to orthopaedic clinics is higher than in those presenting to other specialties, in view of the high proportion of fractures caused by IPV (eg, 80% in this study).

        So the incidence is similar (if not higher in primary care), but the severity may be worse.

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    • by Ryan on August 20th, 2013 at 16:25

      Thank you, makes more sense now. (I did read the link- but did not have access to full article).

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