Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=41262429
&cmd=llinks): Failed to open stream: HTTP request failed! HTTP/1.1 429 Too Many Requests
in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 215
Missed Opportunities in Orthopaedics for Intimate Partner Violence
Identification: A Retrospective Review Over 24 years
#MMPMID41262429
Lavoie-Gagne O
; Brown K
; Kwon A
; Suneja N
; Weaver MJ
; Dyer GS
; Harris MB
; Khurana B
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41262429
show ga
BACKGROUND: Intimate partner violence (IPV) commonly manifests as a
musculoskeletal injury, yet the majority of orthopaedic surgeons estimate IPV to
be rare in "their" orthopaedic patients. This work aimed to (1) provide education
on the prevalence and manifestations of IPV, (2) investigate departmental
referral patterns to Domestic Abuse Intervention Programs (DAIP) at 2 high-volume
quaternary-academic centers, and (3) characterize IPV cases identified by
orthopaedic surgery providers. METHODS: The DAIP registry from 2000 to 2024 was
queried for patients reporting IPV. Referrals were categorized by department and
provider type. The electronic health record of patients referred by orthopaedics
was further investigated for case characteristics. Findings were summarized as
count/percentages and referral rates compared via the 2-proportion z-test with
alpha set at 0.05. RESULTS: A total of 11,227 patients were referred to DAIPs.
The most common referrals were from the emergency department (ED) (29.3%; n =
2,393), behavioral health (18.2%; n = 2039), and obstetrics/gynecology (8.4%; n =
939), while only 0.3% (n = 30) patients were referred by orthopaedic surgery
providers (p < 0.001). Patients referred by orthopaedics were commonly female
(83.3%; n = 25) and identified during an inpatient encounter (76.7%; n = 23).
Half (53.3%; n = 16) presented with an injury sustained from abuse, while the
remaining patients presented for scheduled care. Injuries included high-energy
injuries such as subtrochanteric, open tibia, bicondylar tibial plateau, and
nongeriatric elbow fractures. Orthopaedic referrals to DAIPs relied on social
workers (93.3%; n = 28). In the inpatient/ED setting, patients initially
disclosed to bedside nurses (56.0%; n = 14), residents (20.0%; n = 5), and
advanced practice providers (16.0%; n = 4), while patients disclosed to
attendings (60%; n = 3) and fellows (40%; n = 2) in the outpatient setting. The
majority (76.7%; n = 23) of patients reporting IPV-only interacted with
orthopaedic providers in the 6 months preceding IPV disclosure. IPV
identification led to patient safety coordination (16.7%; n = 5), alternative
care plans (23.3%; n = 7), and resource assistance applications (23.3%; n = 7).
Patients referred to DAIPs remained engaged in services a median 6.8 years after
referral. CONCLUSIONS: Orthopaedic surgery referrals to DAIPs are significantly
lower than other specialties, highlighting missed opportunities for intervention
in both inpatient and outpatient contexts. Enhancing IPV awareness and screening
in orthopaedics could improve patient safety and long-term support. Integration
of artificial intelligence has the potential to facilitate efficient targeted
screening within existing practice models. LEVEL OF EVIDENCE: Level III
(retrospective cohort). See Instructions for Authors for a complete description
of levels of evidence.
free
free
free
