Using Hospital Emergency Room Data to Assess Intimate Violence-Related Injuries

• Author: Kevin J. Strom
• DOI: 10.3818/JRP.2.1.2000.1
• Date: 01 June 2000
• Published date: 01 June 2000
• Subject Matter: Article

Intimate Violence Injuries • 1

*Using Hospital Emergency Room

Data to Assess Intimate Violence-

Related Injuries

Kevin J. Strom

I would like to thank Robert Brame, Sally Simpson, and Charles Wellford from the Uni-

versity of Maryland, College Park, and Thomas Hester, Marika Litras, and Steven Smith

from the Bureau of Justice Statistics for their helpful editorial comments on earlier drafts

of this paper. I would also like to thank two anonymous referees for their comments.

Opinions expressed in this article are those of the author and do not necessarily reflect the

views of the University of Maryland, the Bureau of Justice Statistics, or the U.S. Depart-

ment of Justice.

JUSTICE RESEARCH AND POLICY, Vol. 2, No. 1, Spring 2000.

© 2000 Justice Research and Statistics Association

* Abstract

Hospital emergency department statistics represent a distinct and underutilized source

for measuring nonfatal intimate violence, especially those cases that result in serious

injury. This study attempts to gain an improved understanding of these types of inci-

dents through the use of the National Electronic Injury Surveillance System (NEISS), a

nationally representative sample of U.S. hospital emergency departments. Findings

from the Bureau of Justice Statistics’ (BJS) intentional injury supplement of NEISS,

the Study of Injured Victims of Violence (SIVV), indicate that emergency departments

treated more than 243,000 intimate violence-related injuries in 1994. Eighty-four

percent of people intentionally injured by an intimate were female. Weapons were

used in 27% of all intimate violence cases, but were more likely to have been used in

injuries inflicted on male patients than female patients (68% of male injuries versus

19% of female injuries). Findings from the SIVV also indicate that previous surveys

may have undercounted intimate violence injuries treated in hospital emergency de-

partments, as estimates were 4 times greater than the National Crime Victimization

Survey (NCVS) and 1.5 times greater than the National Family Violence Survey (NFVS).

2 • Justice Research and Policy

Each year in the United States, millions of people are victimized at the hands of

an intimate partner. The vast majority of these victims are women, with an

estimated three to four million females physically abused by their husbands, ex-

husbands, boyfriends, or partners on an annual basis in this country (Stark et

al., 1981). Domestic violence is now considered to be the most common cause

of nonfatal injury to women in the United States (Stark & Flitcraft, 1986; Cen-

ters for Disease Control and Prevention [CDC], 1990; Kyriacou et al., 1999).

Studies have found that 80% of abused women reported their injuries at least

once to medical personnel and 40% sought medical treatment a minimum of

five times (Dobash & Dobash, 1979). In many cases, the medical practitioner

may be the first person outside the immediate family that the victim turns to, if

only because the injuries require both medical treatment and some type of ex-

planation from the victim (Stark et al., 1981). This fact, coupled with the fre-

quency with which abused women use emergency medical services, suggests

that hospitals can play a useful role in the identification and measurement of

intimate violence-related incidents.

Estimates on intimate violence and related injures have been derived from

two primary statistical sources, the National Family Violence Survey (NFVS)

and the National Crime Victimization Survey (NCVS) (Straus & Gelles, 1990;

Bureau of Justice Statistics [BJS], 1998). Yet neither survey was designed specifi-

cally for measuring intentional injury (Straus & Gelles). To estimate the preva-

lence and degree of injury sustained from intimate violence, a system collecting

data from a national sample of hospital emergency departments may be better

suited than telephone surveys based on the general population.

The medical system has been criticized for its failure to recognize intimate

violence as a critical issue (American Medical Association [AMA], 1992; Sugg &

Inui, 1992). At least one study indicates that many physicians fail to respond

properly to abuse or, in some cases, to report its occurrence altogether (Sugg &

Inui). Physicians who are unresponsive to domestic abuse often state that they

are concerned about asking too many questions and “opening Pandora’s box”

(Sugg & Inui). Medical practitioners may also be reluctant to address the prob-

lem for fear of offending the patient or may feel powerless to intervene and help.

The American Medical Association’s Council on Ethical and Judicial Affairs has

issued guidelines that urge doctors to question female patients more thoroughly

about the possibility of abuse (AMA, 1992). Yet, these guidelines remain volun-

tary in nature. To date, only California has enacted mandatory reporting re-

quirements for all forms of domestic violence, while several other states are con-

sidering such laws (National Research Council [NRC], 1998). As a result of the

absence of national reporting standards, a variety of responses to domestic vio-

lence exist within the medical community.