Describing Nonfatal Intimate Partner Strangulation Presentation and Evaluation in a Community-Based Hospital: Partnerships Between the Emergency Department and In-House Advocates.
Audrey Bergin, Elizabeth Blumenfeld, Jocelyn C Anderson and 2 others
PMID 34985029WHAT IT FOUND
A hospital partnership between emergency staff and in-house advocates increased the rate of documenting nonfatal strangulation and ordering neck imaging over time.
This suggests that structured multidisciplinary protocols are essential for detecting life-threatening injuries like carotid dissection in survivors of intimate partner violence.
Key findings
01Documentation of strangulation disclosure to all three disciplines (advocate, nurse, prescriber) increased significantly from 53% in 2008 to 91.9% in 2016.
02Dedicated neck imaging rates rose from 15.4% in 2008 to 89% in 2014, but decreased to 59% by 2016 after dedicated staff resources for real-time feedback were reduced.
03Carotid artery dissections were identified in two patients who presented with only neck pain and headache, supporting the use of imaging for these symptoms even without neurological deficits.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study was retrospective and conducted at a single community hospital, limiting generalizability. It only included patients who sought care, potentially missing those with less severe or unrecognized injuries. The sample was primarily African American, which may affect broader applicability. Long-term outcomes were not tracked, as the data were cross-sectional for each patient visit. Documentation quality varied over time and across different staff members. The study was a quality improvement initiative, so no power calculations were performed.
Declared interests
The study was supported by the National Institutes of Health (N.I.H., Extramural). The text does not report other conflicts of interest or specific funding sources for the hospital program.
The easy way to misread this
Do not assume that the increase in imaging rates will be sustained without dedicated administrative support and real-time feedback. The drop in imaging from 89% to 59% after the grant-funded nurse position ended suggests that protocol adherence decays quickly without active monitoring.