Trauma care is, by definition, tertiary prevention or treatment. Understanding the root causes of the injury may aid in better comprehension and treatment of the trauma victim. Improvements in trauma care should incorporate consideration of the psychosocial aspects of such injuries as well as the needs of an impact on the larger health care system. Patients who are victims of family and community violence may have relatively simple traumatic injuries but often have complex psychosocial issues that affect their response to injury. Simply treating the injuries and not intervening with the underlying causes makes recidivism of these patients the likely end result. Early detection and efforts at prevention of interpersonal violence must be part of the trauma center’s prevention program.
Violence may be defined as “the intentional use of physical force against another person or against oneself, which results in or has a high likelihood of resulting in injury or death.”1 Its frequency is documented in the following facts. Homicides and suicides are the second and third leading causes of death among children and youth under the age of 21.2 Domestic violence is the most common cause of injury to women in the United States.3 One person dies every 4 minutes as a result of intentional injury.4 The literature is replete with studies identifying the scientifically proven risk factors for interpersonal violence.2,5–7 Despite this potential knowledge base, physicians are often hesitant to utilize this information.8–10 Early recognition and intervention may prevent future incidents and decrease rates of complications such as posttraumatic stress disorder.2,10–12 The statistics on death and injury from intentional violence are only the tip of the iceberg. The cost to society of violent behavior also includes the price of legal battles, incarceration, and the economic effects on the health care system as a whole, as well as the psychological stress to victims and the families of victims.3,4
The purpose of this chapter is to provide the practicing surgeon with some basic information on intentional violence with a focus on intimate partner and community violence, so that he or she may be a better provider of care for these patients with special needs.
Domestic violence refers to those acts of interpersonal violence resulting in physical or psychological injury to members of the same family or household or to intimate acquaintances in heterosexual or homosexual. Another definition of domestic violence goes further, including “a pattern of coercive control consisting of physical, sexual, and/or psychological assault against former or current intimate partners.”13 Other reports have acknowledged that child14,15 and elder abuse may also be included in the spectrum of “domestic violence.”16 Intimate partner violence (IPV) and elder abuse will be covered here, child abuse will be addressed in the chapter on pediatric trauma.
Domestic violence is not new, it has ...