What Is the Prevalence of Intimate Partner Violence and Traumatic Brain Injury in Fracture Clinic Patients?

Abstract

BackgroundIndividuals in violent intimate relationships are at a high risk of sustaining both orthopaedic fractures and traumatic brain injury (TBI), and the fracture clinic may be the first place that concurrent intimate partner violence (IPV) and TBI are recognized. Both IPV and TBI can affect all aspects of fracture management, but prevalence of TBI and comorbid TBI and IPV is unknown.Questions/purposes(1) What are the previous-year and lifetime prevalence of IPV and TBI in women presenting to an outpatient orthopaedic fracture clinic? (2) What are the conditional probabilities of TBI in the presence of IPV and the reverse, to explore whether screening for one condition could effectively identify patients with the other? (3) Do patients with TBI, IPV, or both have worse neurobehavioral symptoms than patients without TBI and IPV?MethodsThe study was completed in the fracture clinic at a community Level 1 trauma center in Southern Ontario from July 2018 to March 2019 and included patients seen by three orthopaedic surgeons. Inclusion criteria were self-identification as a woman, age 18 years or older, and the ability to complete forms in English without assistance from the person who brought them to the clinic (for participant safety and privacy). We invited 263 women to participate: 22 were ineligible (for example, they were patients of a surgeon who was not on the study protocol), 87 declined before hearing the topic of the study, and data from eight were excluded because the data were incomplete or lost. Complete data were obtained from 146 participants. Participants’ mean age was 52 ± 16 years, and the most common diagnosis was upper or lower limb fracture. Prevalence of IPV was calculated as the number of women who answered “sometimes” or “often” to direct questions from the Woman Abuse Screening Tool, which asks about physical, emotional, and sexual abuse in the past year or person’s lifetime. The prevalence of TBI was calculated as the number of women who reported at least one head or neck injury that resulted in feeling dazed or confused or in loss of consciousness lasting 30 minutes or less on the Ohio State University Traumatic Brain Injury Identification Method, a standardized procedure for eliciting lifetime history of TBI through a 3- to 5-minute structured interview. Conditional probabilities were calculated using a Bayesian analysis. Neurobehavioral symptoms were characterized using the Neurobehavioral Symptom Inventory, a standard self-report measure of everyday emotional, somatic, and cognitive complaints after TBI, with total scores compared across groups using a one-way ANOVA.ResultsPrevious-year prevalence of physical IPV was 7% (10 of 146), and lifetime prevalence was 28% (41 of 146). Previous-year prevalence of TBI was 8% (12 of 146), and lifetime prevalence was 49% (72 of 146). The probability of TBI in the presence of IPV was 0.77, and probability of IPV in the presence of TBI was 0.36. Thus, screening for IPV identified proportionately more patients with TBI than screening for TBI...

CORR Insights®: What Is the Prevalence of Intimate Partner Violence and Traumatic Brain Injury in Fracture Clinic Patients?

“…The comorbid incidence of traumatic brain injury (TBI) is unknown. In this study, Turkstra et al [7] found the prevalence of IPV in the previous year among patients in orthopaedic fracture clinic to be 20%, with the conditional probability of 66% that those patients had TBI. The prevalence is staggering.…”

“…A follow-up study to the current paper in CORR ® [7] could be performed by asking patients in whom IPV and/or TBI were identified about whether they took advantage of the resources provided. In an anonymous manner, perhaps the agencies to whom we refer our patients to end the cycle of IPV could give data on the number of patients who took advantage of the resource.…”

“…We need a quick and easy screening tool for patients that can be used by a busy clinician to ask the right questions and recognize and treat IPV and TBI appropriately. The authors [7] cite the Woman Abuse Screening Tool [1] as used by the PRAISE investigators [5, 6], asking patients at every clinic visit if they have ever been physically, sexually, or emotionally abused by an intimate partner (with the options of always, sometimes, and never). Screening for TBI was done using a slightly more time-consuming tool, a 3-minute to 5-minute structed interview (the Ohio State University Traumatic Brain Injury Identification Method [2]).…”

Editor’s Spotlight/Take 5: Do Patients Reporting Fractures Experience Food Insecurity More Frequently Than the General Population?

“…Dr. Leopold: Food insecurity rarely travels alone; it’s one of many social stressors that patients who have experienced physical trauma are more likely to be exposed to. Your paper reminded me of a recent one about intimate partner violence, which also is disconcertingly common in fracture clinics [9]. How does the good trauma surgeon manage to look after the whole patient, given the diversity, severity, and interactions of social stressors like these?…”

“…If a person has to choose between money for food, money for a cab fare to the clinic, or money for antibiotics for that inflamed-looking surgical incision, well, that’s not a choice we’d like to see our patients make. And the problem may go deeper—we know that individuals who have experienced intimate partner violence are more likely to have fractures [9], and food insecurity is tightly bound up with intimate partner violence [8]. These are associations, not causal links, but it isn’t hard to imagine a causal connection between food insecurity and intimate partner violence if one thinks through the main Bradford Hill criteria for causality [1], and indeed some analyses support just such a causal link [5].…”