Intimate Partner Violence: Development of a Brief Risk Assessment for the Emergency Department

Authors

  • Carolyn Snider MD, MPH,

    1. From the Emergency Department, St. Michael’s Hospital, and the Division of Emergency Medicine, Department of Medicine, University of Toronto (CS), Toronto, Ontario, Canada; the Johns Hopkins Bloomberg School of Public Health, Health Policy and Management (DW), Baltimore, MD; Independent Research Professional (CSO), New York City, NY; and the Johns Hopkins University, School of Nursing (JC), Baltimore, MD.
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  • Daniel Webster ScD, MPH,

    1. From the Emergency Department, St. Michael’s Hospital, and the Division of Emergency Medicine, Department of Medicine, University of Toronto (CS), Toronto, Ontario, Canada; the Johns Hopkins Bloomberg School of Public Health, Health Policy and Management (DW), Baltimore, MD; Independent Research Professional (CSO), New York City, NY; and the Johns Hopkins University, School of Nursing (JC), Baltimore, MD.
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  • Chris S. O’Sullivan PhD,

    1. From the Emergency Department, St. Michael’s Hospital, and the Division of Emergency Medicine, Department of Medicine, University of Toronto (CS), Toronto, Ontario, Canada; the Johns Hopkins Bloomberg School of Public Health, Health Policy and Management (DW), Baltimore, MD; Independent Research Professional (CSO), New York City, NY; and the Johns Hopkins University, School of Nursing (JC), Baltimore, MD.
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  • Jacquelyn Campbell PhD, RN

    1. From the Emergency Department, St. Michael’s Hospital, and the Division of Emergency Medicine, Department of Medicine, University of Toronto (CS), Toronto, Ontario, Canada; the Johns Hopkins Bloomberg School of Public Health, Health Policy and Management (DW), Baltimore, MD; Independent Research Professional (CSO), New York City, NY; and the Johns Hopkins University, School of Nursing (JC), Baltimore, MD.
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  • Presented at the Canadian Association of Emergency Physicians conference, Calgary, Alberta, Canada, June 7–10, 2009.

  • The data were obtained from the publically available intimate partner violence Risk Assessment Validation Evaluation (RAVE) study. The RAVE study was supported by a grant from the U.S. Department of Justice (Grant 2000-WT-VX-0011, NCJ# 209731). The amount of support was $1,323,241. Dates of support 2000–2005 (final PubMed l report published in 2005).

Address for correspondence and reprints: Carolyn Snider, MD, MPH; e-mail: sniderc@smh.toronto.on.ca.

Abstract

Objectives:  Women assaulted by intimate partners are frequently patients in emergency departments (EDs). Many victims and health care providers fail to take into account the potential risks of repeat partner violence. The objective of this study was to use data from a larger study of domestic violence risk assessment methods to develop a brief assessment for acute care settings to identify victims at highest risk for suffering severe injury or potentially lethal assault by an intimate partner or former partner.

Methods:  Victims of intimate partner violence (IPV) were interviewed twice between 2002 and 2004. The baseline interview included the 20 items of Campbell’s Danger Assessment (DA; predictor). The follow-up interview, conducted 9 months later on average, assessed abuse inflicted since the baseline interview (outcome). Multiple logistic regression was used to identify questions on the DA most predictive of severe abuse and potentially lethal assaults. Female IPV victims were recruited from New York City family courts, Los Angeles County Sheriff’s Department 9-1-1 calls, New York City and Los Angeles shelters, and New York City hospitals; 666 women responded to the DA at baseline, and 60% participated in follow-up interviews.

Results:  Severe injuries or potentially lethal assaults were experience by 14.9% of retained study participants between the baseline and follow-up interviews. The best brief prediction instrument has five questions. A positive answer to any three questions has a sensitivity of 83% (95% confidence interval = 70.6% to 91.4%).

Conclusions:  This instrument can help predict which victims may be at increased risk for severe injury or potentially lethal assault and can aid clinicians in differentiating which patients require comprehensive safety interventions.

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