Evaluation and Management of Intimate Partner Violence in the Emergency Department - Trauma EXTRA Supplement (Trauma CME, Domestic Violence CME, and Ethics CME) -
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Publication Date: April 2023 (Volume 25, Supplement 04)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 04/20/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, 4 Domestic Violence credits, and 4 Ethics credits, subject to your state and institutional approval.

Authors

Gilberto A. Salazar, MD, FACEP

Associate Professor, Department of Emergency Medicine, University of Texas Southwest Medical Center, Dallas, TX

Jo-Anna Palma, MD

Department of Emergency Medicine, University of Texas Southwest Medical Center, Dallas, TX

Maria Box, MD

Department of Emergency Medicine, University of Texas Southwest Medical Center, Dallas, TX

Davindeep Brar, MD

Department of Emergency Medicine, University of Texas Southwest Medical Center, Dallas, TX

Peer Reviewers

Diksha Mishra, MD

Emergency Medicine Faculty, Weill Cornell Medical Center, New York, NY

Kate Vander Tuig, MPH

Program Manager, National Health Initiatives, Futures Without Violence, Oakland, CA

Abstract

Intimate partner violence (IPV) and emergency medicine intersect when individuals experiencing IPV present to emergency departments for medical care, either on their own or when brought in by law enforcement authorities for medical evaluation and social services. Coordination of care is required, with particular attention paid to the sensitive nature of the patient’s presentation and with an emphasis on trauma-informed care. Emergent medical needs must be balanced with concerns for the patient’s emotional well-being and the need for advocacy and social services. This supplement reviews best practices and evidence-based recommendations for the evaluation and management of patients who have experienced IPV, with a focus on the considerations for traumatic injuries in these patients.

Case Presentations

CASE 1

A 23-year-old woman with no past medical history presents to the ED with a complaint of neck pain…

During the history, the patient first states that she fell down the stairs, then a few minutes later says that large boxes fell on her neck. You note these conflicting details regarding the etiology of her neck pain.
On examination, the patient has an occipital scalp hematoma, but no other cranial deformity, periorbital ecchymosis, or facial trauma. Bilateral neck ecchymosis is noted, along with edema that is worse on the right side.
She has full range of motion of the neck. Cranial nerves are intact, and pulses to bilateral upper extremities are full and equal.
The patient becomes tearful during the exam and discloses that her husband hit her on the head with a heavy book and wrapped his hands around her neck during an argument. She denies sexual assault or other injuries but states she does not feel safe at home. She denies active suicidal and homicidal ideations.
You order lab work, urinalysis, noncontrast CT of the brain, and a CT angiogram of the head and neck. While you wait for lab and imaging results, you consider the best next steps for this patient…

CASE 2

A 36-year-old transgender woman presents to the ED with complaints of rectal pain and discharge...

The patient states that she was sexually assaulted by her partner 2 days ago.
She says that during a confrontation with her partner about concerns of infidelity, the partner offered the patient an alcoholic beverage. The patient drank the beverage and has no recollection of the events that followed, but awakened later with complaints of rectal pain and bloody drainage.
You order lab work including CBC, type and screen, basic metabolic panel, and HIV serology. Given her report of sexual assault, you consider how to proceed with the evaluation of this patient…

CASE 3

An 18-year-old woman presents to the ED with abdominal pain...

The patient is accompanied by a man who identifies himself as her boyfriend.
When you ask the patient about her chief complaint, the man interrupts her reply and says the patient believes she has a urinary tract infection.
You note that the patient is avoiding eye contact with you. When you ask her to describe her symptoms, the man interrupts again and requests a “quick test and antibiotics.”
You are concerned that this patient does not seem to feel free to speak for herself…

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