How can radiologists help victims of intimate partner violence?

Victims of intimate partner violence—physical, sexual or psychological harm caused by a current or former partner or spouse—undergo four times more imaging in a five-year period than non-victims, according to research published Feb. 5 in Radiology. What can radiologists do to help them?

Recent statistics from the National Coalition Against Domestic Violence found that more than 10 million women and men in the U.S. are physically abused by an intimate partner every year—and that can also include mental and emotional abuse. Additionally, one in four women and one in nine men will experience intimate partner physical abuse in their lifetime and victims are more likely to experience a wide array of physical health problems, as well as emotional distress, depression or have suicidal thoughts.  

Although there is little research about the role of imaging in detecting intimate partner violence, senior author Bharti Khurana, MD, a radiologist at Brigham and Women’s Hospital and assistant professor of radiology at Harvard Medical School in Boston, and colleagues believe radiologists can and should identify patterns of injury from imaging scans and work closely with referring providers to provide care for victims.  

“Medical images can offer early clues of intimate partner violence based on location and pattern of both new and old injuries,” Khurana said in a prepared statement.

For their study, the researchers reviewed electronic medical records from 185 patients referred by the Brigham and Women’s Hospital emergency department (ED) to the intimate partner violence support program from January 2015 to October 2016. The patients’ records were then compared to 555 controls who were also seen in the ED. Reports of all patient imaging exams performed within the last five years were also reviewed.  

Overall, 96 percent of all intimate partner violence victims were women and had an average age of 34 years old. Thirty-seven percent were black and 28 percent were Hispanic, according to the researchers.  

On average, the team found that victims of intimate partner violence underwent roughly four times more imaging exams in the preceding five years compared to the controls. Additionally, the risk of acute fractures, pregnancy loss and intrauterine growth restriction were two to four times higher for victims.  

Intimate partner violence victims also were more likely to be homeless (28 percent), have a psychiatric history (64 percent) or experiencing substance abuse (24 percent). Physical abuse was the most common form of intimate partner violence (84 percent), followed by emotional and verbal abuse (44 percent) and sexual abuse (15 percent).   

“Radiologists are in a unique position to share objective findings unbiased by interactions with the victim and potential abuser,” Khurana said, noting that the study has expanded to include the hospital's orthopedic, primary care, women’s health, social work and legal departments as well as Massachusetts General Hospital and Boston Medical Center. 

With their research, Khurana and colleagues hope to develop an integrated system that uses patterns from imaging and clinical data to detect and classify injuries and automatically alert clinicians if a patient’s injuries have a high or low risk of being a result of intimate partner violence.