Objective:

In collaboration with Brooklyn District Attorney office, we examined and designed a quality improvement study to look at the performance of CT imaging in non-fatal strangulation DV in the emergency department from 8/1/2021 to 3/31/2024 of NYC Health and Hospitals System (NYCHH).

Background:

The incidence of domestic violence (DV) can vary from 2 to 4 million in a year. Domestic violence can be broad in definition and not limited to physical assault. Studies suggest that less than 10% of these cases are diagnosed correctly in the emergency room.

Design/Methods:

We developed a non-fatal strangulation pathway in the emergency department for DV patients. We examined the use of CT head and CTA head and neck. Cases were abstracted with diagnoses of DV and asphyxiation. Strategies were employed to encourage and improve the utilization of pathway.

Results:

In total, 2163 domestic violence cases were abstracted from electronic medical records.
63% (n=1363) female
5.2% (113) male
31.7% (n=687) did not select for sex (NOA)
The percentage of CT performance during 8/1/2021 through 3/31/2024 was 5.5% (116/2163). Upon further evaluation, the percentage of female cases imaged was 5.5% (75/116); by contrast, male cases were imaged at 24.8% (28/116), and NOA 1.9% (13/116).
The odds ratio of CT performances in noted cases was 4.5 [95% CI 2.8016-7.2381], 13.0946 [6.5861-26.0349], 2.9 [1.6024-5.277], Male to female cases, male to NOA, and Female to NOA, respectively.

Conclusions:

The identification of stroke risk factors from a domestic violence incident is a novel approach and has not been fully elucidated.  In this study, we have observed a low utilization of imaging to rule out dissection; there is a suggestion of disparity among the sexes in diagnosis.  The observation from this study involving all hospitals in the NYCHH system reveals a need to better educate and improve diagnosis of domestic violence.