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  • The Centers for Disease Control and Prevention estimate that 12.7 million women and men have been affected by intimate partner violence.

  • The World Health Organization reported that 35% of woman worldwide have experienced physical or sexual violence.

  • The HITS (Hurt, Insult, Threaten, Scream) questionnaire has been validated for screening for intimate partner violence.

  • Older people with cognitive impairments, physical disabilities, or mental health problems are at higher risk for elder abuse.

  • Fractures in places besides the hip, vertebrae, or wrists and spiral fractures are suspicious for elder abuse.

  • The Elder Abuse Suspicion Index is a six-question screening tool validated in the ambulatory care setting.

  • The United States has the highest rate of youth homicides out of all the industrialized nations.

  • A gun in the home is associated with a 40-fold greater chance of killing a family member or acquaintance.

  • Individuals who participate in gangs are more likely to be involved in fights, take weapons to school, and use drugs or alcohol at school.


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 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 by the following facts:

  • Suicides and homicides are the second and third leading causes of death among children and youth under the age of 21.2

  • Overall, injury and violence remain the leading cause of death for persons age 1 to 44.2

  • One person dies every 4 minutes as a result of intentional injury.3

  • Intimate partner violence is the most common cause of injury to women in the United States, causing nearly 2 million injuries a year.4-7

The literature is replete with studies identifying risk factors for interpersonal violence.2,8-10 Despite this potential knowledge base, physicians are often hesitant to use this information.11-13 Early recognition and intervention may prevent future incidents and decrease rates of complications such as posttraumatic stress disorder.13-15 The statistics on death and injury from intentional violence are only the tip of the iceberg. The cost to society of violent behavior ...

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