Longitudinal imaging history in early identification of intimate partner violence

Using Radiology as a Screening Tool to Identify Intimate Partner Violence

OBJECTIVE

To identify imaging utilization patterns and radiologically evident injuries suggestive of intimate partner violence (IPV).

METHODS

This retrospective case-control study analyzed historical imaging reports from women reporting physical IPV between 2013 and 2018 ("cases"; n = 265; 6,401 imaging studies) and age- and race-matched controls not reporting IPV (n = 875; 13,462 imaging studies). Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression to compare imaging utilization by organ system or modality. Logistic regression calculated adjusted odds ratios (aORs) for canceled studies and studies conducted in the emergency department (ED), overnight, or on weekends. Injury patterns were assessed by calculating aIRRs of injury by anatomic site and comparing synchronous and asynchronous injury detection. A time-to-event analysis using Cox proportional hazards regression compared the cumulative incidence of asynchronous injury in patients with at least one injury.

RESULTS

Patients experiencing IPV underwent imaging at a higher rate than controls (aIRR: 1.5, 95 confidence interval [CI]: 1.5-1.6). They were more likely to cancel screening mammograms (aOR: 3.2, 95% CI: 1.8-5.7) and undergo imaging in the ED (aOR: 3.8, 95% CI: 2.9-5.0), overnight (aOR: 1.6, 95% CI: 1.3-1.9) and on weekends (aOR: 1.3, 95% CI: 1.1-1.5). The injury rate was higher in cases (aIRR: 15.1, 95% CI: 12.5-18.1), particularly for cranial (aIRR: 104.5, 95% CI: 14.2-770.1), facial (aIRR: 47.0, 95% CI: 18.9-117.0), and thoracic (aIRR: 32.6, 95% CI: 11.5-92.2) injuries. Cases were more likely to have multiple injuries in a single encounter (aOR: 4.7, 95% CI: 1.5-14.1) or multiple encounters with unique injuries (hazard ratio: 4.9, 95% CI: 2.6-9.3).

CONCLUSION

Patients experiencing IPV had higher rates of imaging studies, imaging utilization in the ED, weekend, and overnight settings, screening examination cancellation, and radiologically evident injuries than controls.

Antepartum Intimate Partner Violence: Development of a Risk Prediction Model

Objectives: To explore socio-behavioral, clinical, and imaging findings associated with antepartum intimate partner violence (IPV) and aid in risk stratification of at-risk individuals. Methods: We analyzed electronic medical records during indexed pregnancies for 108 pregnant patients who self-reported antepartum IPV (cases) and 106 age-matched pregnant patients who did not self-report antepartum IPV (controls). Sociodemographic, clinical, and radiology data were analyzed via chi-squared and Fisher's exact tests with p < 0.05 as the threshold for significance. Stepwise logistic regression was applied to derive a risk prediction model. Results: The proportion of cases reporting emotional IPV (76% vs. 52%) and/or physical IPV (45% vs. 31%) during pregnancy significantly increased from prior to pregnancy. Cases were significantly more likely to report prepregnancy substance use (odds ratio [OR] = 2.60; 95% confidence interval [CI]: 1.13-5.98), sexually transmitted infections (OR = 3.48; 95%CI: 1.64-7.37), abortion (OR = 3.17; 95%CI: 1.79, 5.59), and preterm birth (OR = 5.97; 95%CI: 1.69-21.15). During pregnancy, cases were more likely to report unstable housing (OR = 5.26; 95%CI: 2.67-10.36), multigravidity (OR = 2.83; 95%CI: 1.44-5.58), multiparity (OR = 3.75; 95%CI: 1.72-8.20), anxiety (OR = 3.35; 95%CI: 1.85-6.08), depression (OR = 5.58; 95%CI: 3.07-10.16), substance use (OR = 2.92; 95%CI: 1.28-6.65), urinary tract infection (UTI) (OR = 3.26; 95%CI: 1.14-9.32), intrauterine growth restriction (OR = 10.71; 95%CI: 1.35-85.25), and cesarean delivery (OR = 2.25; 95%CI: 1.26-4.02). Cases had significantly more OBGYN abnormalities on imaging and canceled more radiological studies (OR = 5.31). Logistic regression found housing status, sexually transmitted infection history, preterm delivery history, abortion history, depression, and antepartum UTI predictive of antepartum IPV. The risk prediction model achieved good calibration with an area under the curve of 0.79. Conclusions: This study identifies significant disparities among patients experiencing antepartum IPV, and our proposed risk prediction model can inform risk assessment in this setting.

Imaging of Intimate Partner Violence, From the AJR Special Series on Emergency Radiology

Intimate partner violence (IPV) is a highly prevalent public health issue with multiple adverse health effects. Radiologists are well suited to assessing a patient's likelihood of IPV. Recognition of common IPV injury mechanisms and resulting target and defensive injury patterns on imaging and understanding of differences between patients who have experienced IPV and those who have not with respect to use of imaging will aid radiologists in accurate IPV diagnosis. Target injuries often involve the face and neck as a result of blunt trauma or strangulation; defensive injuries often involve an extremity. Awareness of differences in injury patterns resulting from IPV-related and accidental trauma can aid radiologists in detecting a mismatch between the provided clinical history and imaging findings to support suspicion of IPV. Radiologists should consider all available current and prior imaging in assessing the likelihood of IPV; this process may be aided by machine learning methods. Even if correctly suspecting IPV on the basis of imaging, radiologists face challenges in acting on that suspicion, including appropriately documenting the findings, without compromising the patient's confidentiality and safety. However, through a multidisciplinary approach with appropriate support mechanisms, radiologists may serve as effective frontline physicians for raising suspicion of IPV.