There was a higher incidence and severity of physical intimate partner violence (IPV) among patients seen at a large, academic medical center in the United States during the COVID-19 pandemic compared to the previous three years, according to a new study published in Radiology.
Our study showed a higher incidence of physical IPV, both in absolute number and proportion, with more serious injuries despite fewer patients reporting IPV. This indicates that victims report to healthcare in the late stages of the addiction cycle. Fear of infecting and closing outpatient sites can prevent victims of minor physical or emotional abuse from seeking help compared to the pre-pandemic era. “
Bharti Khurana, CEO, Chief Investigator and Head of the Trauma Imaging Research and Innovation Center at Brigham and Women̵7;s Hospital in Boston, Massachusetts
Social distancing has been shown to be effective in controlling the spread of coronavirus but with negative socio-economic and psychological effects. Service-oriented economies have increased unemployment and a higher incidence of substance abuse and alcohol abuse and mental illness.
Since the outbreak of COVID-19, reports of IPV have increased worldwide during mandatory “lockdowns” to limit the spread of the virus.
Dr. Khurana and colleagues intended to assess the prevalence, pattern, and severity of IPV-related injuries at Brigham and Women’s Hospital during the COVID-19 pandemic. The demographics, clinical presentation, injuries, and radiological findings in patients who reported physical abuse that occurred from IPV between March 11 and May 3, 2020 were compared with the same period over the past three years.
Data from 26 physical IPV victims from 2020 (37 +/- 13 years, 25 women) were evaluated and compared with 42 physical IPV victims (41 +/- 15 years, 40 women) from 2017 to 2019. While the total number of patients reporting of IPV was lower, the incidence of physical IPV was 1.8 times greater during the pandemic. Five victims of serious abuse were identified in 2020 (5/26 = 19%) compared with one of the previous years.
The total number of deep injuries (injuries to deep internal organs) was 28 in 2020 against 16 from 2017 to 2019. The number of deep injuries per victim was 1.1 in 2020 compared to 0.4 from 2017 to 2019. The incidence of high-risk abuse defined by mechanism (damage due to suffocation, stab wounds, burns or use of weapons such as knives, weapons and other objects that can cause deep damage) was twice as large. Patients with IPV during the COVID-19 pandemic were more likely to be ethnically white. Seventeen (65%) victims in 2020 were white compared to 11 (26%) in previous years.
“During the pandemic, the victims experienced more chest and abdominal injuries than in previous years,” said co-author Babina Gosangi, MD, associate professor of radiology at Yale New Haven Health in New Haven, Connecticut, and former emergency X-ray fellow at Brigham and Women’s Hospitals. “For example, one victim suffered multiple bilateral rib fractures with right pneumothorax and bilateral lung contusions – which required hospitalization for more than ten days – after repeatedly punching her in the chest. Another victim stabbed her abdomen and had hair on her liver and kidney.”
It is challenging to help IPV victims in the time of the pandemic when caregivers are overwhelmed by COVID-19 patients. In addition, options for IPV victims to seek help have decreased. Many outpatient clinics no longer see as many patients in person due to the virus and instead turn their services to virtual consultation. Telecom health visits limit the ability to visualize bruises or other signs of physical trauma and inhibit the caregiver’s ability to gather nonverbal clues.
It can also be difficult for victims who are at home to report IPV, and healthcare providers may omit IPV screening issues entirely on these calls due to the patient’s limited privacy. Therefore, the role of radiologists in identifying victims of IPV through imaging tests has become crucial.
By recognizing high image usage, location and image patterns specific to IPV, old injuries of various body parts and injuries that are incompatible with the presumed history, radiologists can identify IPV victims even if the victims do not come.
Dr. Khurana, who is also an assistant professor of radiology at Harvard Medical School in Boston, sees this as an opportunity for radiologists to use their expertise to provide patient-centered care and play a critical role in facilitating early intervention, preventing life-threatening injuries and saving lives by early identification of IPV victims.
“As caregivers, we lack the ability to identify victims early in the cycle during the pandemic,” she said. “There is underreporting of victims, accentuated by fear of seeking care due to COVID-19. At the same time, IPV-related injuries can be overlooked or misunderstood, as our frontline physicians are overwhelmed by a large number of COVID-19 patients on the emergency department. “
The researchers emphasize that radiologists and other care providers should proactively participate in identifying IPV victims and reaching out to vulnerable communities as an important service during pandemics and other crisis situations.
Radiological Society of North America
Gosangi, B., et al. (2020) Exacerbation of physical intimate partner violence during COVID-19 lockdown. Radiology. doi.org/10.1148/radiol.2020202866.