Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Intimate partner violence (IPV) represents a pervasive and costly public health issue. Many IPV victims seek care in the emergency department (ED) due to injuries or related medical complaints; yet a substantial number of cases remain undetected. The challenge lies in implementing effective screening tools within the demanding environment of an ED. In this study we aimed to assess the efficacy of two brief IPV screening tools— the single question, “Have you been hit, kicked, punched, or otherwise hurt by someone in the past year?” and the 4-item Ongoing Violence Assessment Tool—and to compare them to the more comprehensive Index of Spouse Abuse, a validated 30-item survey that is considered the gold standard for IPV assessment. Our objective was to identify improved strategies for IPV screening in the busy ED setting.

Methods: In this prospective study, every third English-speaking female patient 18-55 years of age presenting to our ED triage was invited to participate. Each participating patient was sequentially assigned to either the single question or the ongoing assessment screening group. Both groups completed feedback surveys about their experiences and the Index of Spouse Abuse survey. We used chi-square tests to compare categorical variables, and we used frequency tables to calculate the sensitivity, specificity, positive predictive value, and negative predictive value of each IPV screening tool. We compared test characteristics between the Ongoing Violence Asessment Tool or the single question screening tool to the Index of Spouse Abuse using the Fisher exact test. Mean duration was compared using two-tailed Student t-tests. The primary outcome was the sensitivity and specificity of the single question assessment. and the 4-item Ongoing Violence Assessment Tool, using the Index of Spouse Abuse as the gold standard for IPV screening. Secondary outcomes were to record the length of time needed to screen with the single question assessment and the Ongoing Violence Assessment Tool and to collect participant feedback on the two screening tools.

Results: A total of 400 participants were enrolled in the study and completed the designated surveys. Screening time was significantly shorter in the single question group (median 6 seconds) compared to the ongoing assessment group (median13 seconds; P < .001). Feedback surveys did not reveal significant differences between the two groups. When compared to the Index of Spouse Abuse, the single question tool exhibited sensitivity of 53.3% and specificity of 94.1%, while the ongoing assessment demonstrated slightly higher sensitivity levels of 75.0% and lower specificity of 92.8%. For the single question assesssment, the positive predictive value was 42.1% and negative predictive value was 96.1%. For the Ongoing Violence Assessment Tool, the positive predictive value was 40.1% and the negative predictive value was 98.2%.

Conclusion: The 7-second reduction in overall IPV screening time for the single question compared to the 4-item Ongoing Violence Assessment Tool likely has little clinical benefit, especially with its low sensitivity. Further studies are needed to identify the optimal screening tool for intimate partner violence in the emergency department.