ACCURACY OF 3 BRIEF SCREENING QUESTIONS FOR DETECTING PARTNER
VIOLENCE IN THE EMERGENCY DEPARTMENT
Population-based studies suggest
that 8% to 12% of women experience some form of partner violence in any one year. One
characteristic of partner violence is that the threats, intimidation, control, and
physical battering escalate over time.
More than half of all women murdered in the United States are killed by a current or
former partner.
Consequently, the AMA Council on Ethical and Judicial Affairs has stated—" due
to the prevalence and medical consequences of domestic violence, physicians should
routinely inquire about abuse as part of the medical history."
The objective of this study was to devise a brief screening instrument to detect partner
violence (physical and non-physical abuse).
Conclusion:
The screen detected a large number of abused women.
STUDY
Prospective study in 2 urban hospital-based emergency departments (EDs) entered over 300
randomly selected women (median age 36; 19% black, 45% white, 30% hispanic).
To encourage participation, disclosure, and safety, all visitors, relatives, and
partners were asked to leave the room.
A 3-question Partner Violence Screen (PVS) was compared against 2 detailed standard
violence measures—the Index of Spouse Abuse (ISA) and the Conflict Tactics Scale
(CTS).
(See p 1358 for discussion. )
The PVC:
Have you been hit, kicked, punched, or otherwise hurt by someone within the past year.
If so, by whom?
Do you feel safe in your current relationship?
Is there a partner from a previous relationship who is making you feel unsafe now?
A positive answer on any 1 of the 3 questions constituted a positive screen.
RESULTS
The prevalence rate of partner violence:
PVC-30%
ISA-24%
CTS-27%
Sensitivity (compared with the other 2 screens as gold standards) in detecting abuse was
65% and 71%; specificity was 80% and 84%.
DISCUSSION
In this study the sensitivity of PVS was suboptimal—about 1/3 false negatives. To
improve on this a direct question must be added to detect women with acute, as well as
past partner violence—"Are you here today because of injury or illness related
to partner violence?"
About 1 in every 4 women using EDs has a history of partner violence (physical or non-
physical).
All women seeking care in EDs should be asked directly about partner violence,
regardless of marital status or current relationships. Patients with positive screens
should have this history documented in the medical record, and they should be offered
support, counseling, or at the very least, referrals to safe shelters and an action plan
to ensure their future safety.
CONCLUSION Three brief directed questions can detect a large number of women who have
a history of partner violence.
JAMA May 7, 1997; 277: 1357-61 Original investigation, first author from Denver Health
Medical Center, Denver, CO
Comment: Domestic violence is a national epidemic. The important thing is to ask.
RTJ
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