July 2009

Mechanism of Injury and Population Predictors of Sexual Assault and Domestic Violence

Background There are over 4 million reported instances of domestic violence annually in the

United States

Methods

Results

Discussion

Michelle Fakler, Miami University, 4th year undergraduate studentEmergency Medicine Research , Summa Health System

Sheila Steer, M.D.P# 12

Study design: Retrospective Chart Review

Medical records are handwritten and stored in the DOVE unit

Patient identity was keyed to maintain anonymity; this key is kept in the DOVE unit at all times

All chart review occurred at St. Thomas hospital

An access database consisting of 474 instances of Domestic Violence was constructed

Stata Software was used to analyze the data

Self-Inflicted scratches

Strangulation Demo

Ligature Marks

Petechiae

Subconjunctival Hemmorrhage

What is DOVE?

DOVE (Developing Options for Violent Emergencies) provides specialized healthcare for victims of acute sexual assault, domestic violence, and elder abuse and neglect. DOVE clinicians provide medico-legal care to these patients, collect physical evidence, and provide expert testimony when needed.

38.9% of Domestic Violence Patients were strangled.

Adapted from D. Hawley MD: Death by Strangulation

Strangulation, a form of asphyxia characterized by closure of the blood vessels and air passages of the neck as a result of external pressure on the neck2, is a common mechanism of injury

Death may occur after 4-5 minutes of pressure1

Lethality risk refers to assessment of a domestic violence victim’s risk of dying from the current situation

These factors impact lethality: the presence of a firearm in the home7,8, threats of suicide/homicide by the abusive partner8, significant bodily injury, and suffering from a significant strangulation episode

The aims of this research are to document the prevalence of strangulation in SUMMA DOVE population from 2005-2008 and to assess lethality risk in this domestic violence population

Only approximately 50% of strangulation victims present with visible injuries2,3,4

Some studies cite incidence rates of 10 - 50% of victims reporting a history of abuse5,6

Exact anatomic location of applied force

Duration of applied force

Quantity of applied force

Surface area of applied force

95.11% of strangulation victims were manually strangled

6 Glass, N., Laughon, K., Campbell, J., Block, C.R., Hanson, G., & Sharps, P.W., Taliaferro, E. (2008). Non-fatal strangulation is an important risk factor for homocide of women. Journal of Emergency Medicine, 35, 329-335.7 Sorenson, S.B. (2006).Firearm use in intimate partner violence: A brief overview. Evaluation Review, 30, 229-236.8 Sorenson, S.B., & Wiebe, D.J. (2004). Weapons in the lives of battered women. American Journal of Public Health, 94, 1412-1417.9 Coker, A.L. (2006).Preventing intimate vartner violence: How we will rise to the challenge. American Journal of Preventative Medicine, 30, 528-529.10 Woods, S.J., Hall, R.J., Campbell, J.C., & Angott, D.M. (2008). Physical health and posttraumatic stress disorder symptoms in women experiencing intimate partner violence. Journal of Midwifery and Women's Health, 53, 538-546.

1 Smith, D.J., Mills, T., & Taliaferro, E.H. (2001). Frequency and relationship of reported symptomatology in victims of intimate partner violence: The effect of multiple strangulation attacks. Journal of Emergency Medicine, 21, 323-329.2 Jennifer Markowitz: Presentation 3 Hawley, D.A., McClane, G.E., & Strack, G.B. (2001). A review of 300 attempted strangulation cases part III: Injuries in fatal cases. Journal of Emergency Medicine, 21, 317-322.4 Strack, G.B., McClane, G.E., & Hawley, D. (2001). A review of 300 attempted strangulation cases part I: Criminal legal issues. Journal of Emergency Medicine, 21, 303-309.5 Sheridan, D.J., & Nash, K.R. (2007). Acute injury patterns of intimate partner violence victims. Trauma, Violence, & Abuse, 8, 281-289.

Over the years 2004-2008, the DOVE Program forensic nurses saw an average of 127 domestic violence patients per year

In 2008 alone, 1576 cases of domestic aggravated assault, battery, and verbal assault were reported to the Akron Police Department; therefore, the statistics concerning this healthcare-seeking population may pertain to a subpopulation suffering from particularly brutal assault

Lethality Factors

0

10

20

30

40

50

60

70

80

90

Consent Releaseof Information

Pregnant Firearm in Home Threats byPerpetrator

Prior ED Care

Pre

vale

nce

(%

)

Signs and Symptoms

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7

Injury to Neck

Visible Injury to Other Areas

Loss of Consciousness

Incontinence

Difficulty Swallowing

Pain with Swallowing

Loss of Memory

Loss of Voice/Voice Changes

Persistant Throat Pain

Breathing Difficulty

Prevalence (%)

Sex

Male

Female

Race

Caucasian

African American

Hispanic

Asian

Other

Relationship of Perpetrator

Intimate Partner

Male Family

Female Family

Friend

NR