Citation

Worster A, Lang E, Thombs BD, Kimber M, Ramsden K, MacMillan H, Sherbino J. CJEM 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Canadian Association of Emergency Physicians, Publisher Cambridge University Press)

DOI

10.1007/s43678-023-00518-x

PMID

37191866

Abstract

The Canadian Association of Emergency Physicians (CAEP) recently published a position statement [1] on intimate partner violence (IPV) and recommended universal screening of all emergency department (ED) patients for IPV exposure. The World Health Organization defines IPV as any behaviour by an intimate partner or ex-partner that causes physical, sexual, or psychological harm, including controlling or coercive behaviours [2]. The strengths of the CAEP statement are its emphasis on the prevalence and economic costs of IPV, the tragic consequences of IPV for individuals and families, and awareness of key signs of IPV exposure for ED clinicians and documentation principles [1, 3]. The statement's recommendations, however, do not align with the evidence on whether screening would reduce IPV or improve health-related outcomes.

We agree with the CAEP position statement that recognition of IPV among patients who present to the ED is critical. Where the CAEP statement missteps is in recommending universal, or routine, IPV screening in the ED. This recommendation does not align with robust evidence from well-conducted randomized controlled trials (RCTs); the evidence from those trials indicates that universal screening does not lead to reductions in IPV or improvements in health outcomes, such as quality of life [4]. However, screening would consume substantial resources and has the potential to increase the risk of harm for patients experiencing IPV [5]. In this commentary, we discuss why universal screening for IPV, defined as systematically administering questionnaires or asking questions of all patients, regardless of presentation, should not be done in ED settings. We describe an evidence-informed alternative of how ED clinicians can recognize and respond safely to IPV without consuming scarce resources.

There is clear evidence that IPV adversely impacts individual's physical, reproductive, and mental health; IPV can occur in any relationship regardless of gender or sexual orientation, although women, transgender, and gender-diverse individuals are at greatest risk [2]. Patients experiencing IPV will frequently seek urgent care; providing care for these individuals is a competency that defines an emergency physician [6]. However, in part because of the complex and potentially stigmatizing nature of IPV, as well as possible fear of partner retribution, many patients experiencing IPV will not self-identify or disclose their IPV experiences to healthcare professionals...

Language: en

Keywords

Guidance; Intimate partner violence; Screening; Emergency medicine; Emergency departments