For both children and adult women, many of these prior visits were for injuries.
Thirty percent of children eventually diagnosed with child abuse did not have the diagnosis recorded until at least their second visit; 7 percent had three or more visits before receiving the diagnosis of abuse. Similarly, in women who were identified as victims of intimate partner violence, half had at least one prior visit to the emergency department without receiving a diagnosis of abuse; 17 percent had four or more visits before receiving an abuse diagnosis.
“I wasn’t surprised by the overall number of visits for abuse,” said Esther Choo, M.D., lead author and researcher in the OHSU Center for Policy and Research in Emergency Medicine. “But I was surprised by the number of previous visits by these patients in which abuse was not recorded as a diagnosis.”
The observational studies of administrative data from 23 rural and urban Oregon emergency departments looked at visits of children younger than 18 and women ages 18 to 64 from February 2001 to August 2005.
Choo found 1,884 visits by women (0.2 percent of all visits by women in this age range) were diagnosed as victims of intimate partner violence. The average woman diagnosed with abuse was 33 and uninsured or on Medicaid. On average, women had 2.5 visits before a diagnosis of intimate partner violence, though 72 percent of their prior visits included at least one injury diagnosis.
For pediatric patients, Choo found 399 visits (0.14 percent of visits by children) were diagnosed as child abuse. Thirty-five percent of the children diagnosed with abuse were younger than five. Forty-nine percent of infants, for whom injury diagnoses should be uncommon, had a previous visit for an injury before being diagnosed as abuse. Once the abuse was recognized in children, repeat emergency department visits were rare (0.5 percent), suggesting effective interventions were available.
“Identifying instances of abuse and intervening early are a challenge in the emergency department,” said Choo. “These studies show us injury-related visits may be a missed opportunity in detecting abuse.”
Choo believes the studies also show that while emergency department staff should remain vigilant in looking for signs of abuse, policy-makers need to be part of the solution as well, by identifying what resources in the health care system can best assist clinicians in detecting and addressing family violence.
Choo presented her studies this week at the American College of Emergency Physicians annual meeting. The research was funded the National Heart, Lung and Blood Institute Resuscitation Outcomes Consortium (ROC) training grant, the Robert Wood Johnson Foundation and the Oregon Office for Health Policy and Research.
Oregon Health & Science University is the state’s only health and research university, and Oregon’s only academic health center. OHSU is Portland's largest employer and the fourth largest in Oregon (excluding government), with 12,400 employees. OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.