Radiologic signs of injury could help identify victims of intimate partner violence, according to a study presented RSNA.
“Radiologists must be aware that intimate partner abuse is a common public health problem,” said study author Elizabeth George, M.D., a radiology resident at Brigham and Women’s Hospital in Boston. “It affects one in four women in the United States. So many of the patients we encounter may have this unfortunate story.”
Medical images sometimes offer early clues that abuse is taking place. In fact, the case that inspired the study’s principal investigator, Bharti Khurana, M.D., emergency radiology fellowship program director at Brigham and Women’s Hospital., involved a young woman who arrived at the Emergency Department with an acute nasal bone fracture superimposed on an old, healed fracture. While going through prior medical images of the patient on the hospital’s picture archiving and communication system, or PACS, Dr. Khurana identified a recent wrist fracture. This pattern of recurrent injury made her voice her suspicion of intimate partner violence, a finding the referring physician initially had not suspected.
“This also led us to connect with some of our Emergency Department staff physicians and colleagues who were already working on the clinical and social aspects of this issue,” Dr. Khurana said. “We went on to design this research study to objectively assess the clinical and radiologic findings in this population.”
The study, which reviewed electronic medical records from patients referred to domestic abuse and sexual assault programs from January to October 2016, found characteristic injuries among the patients.
A majority of the 87 intimate partner violence victims were female (95%) and African-American (40%), with a mean age of 34.7 years. A total of 665 radiology exams were performed in this population over five years. The most commonly performed exam was chest X-ray, followed by obstetric ultrasound and musculoskeletal X-rays.
The 35 sexual assault victims were younger (mean age 27.3 years), majority female (91%), and African-American (46%). A total of 109 radiology exams were performed in this population over five years. The most commonly performed exam was chest X-ray, followed by head CT, pelvic ultrasound, and musculoskeletal X-rays. There were fewer traumatic injuries in this population.
The intimate partner violence victims were more likely to be homeless, while the sexual assault victims were more likely to suffer from illicit drug abuse.
Along with providing information on presenting injuries, radiologists have access to a wealth of information through PACS that can show prior fractures linked to abuse. Old, healed fractures look distinct from acute fractures, Dr. Khurana said, and may be evident in the form of bone remodeling, deformity or focal bone thickening.
Findings suggestive of abuse should trigger a conversation between the radiologist and the referring physician, the researchers noted. Additional communications with the patient would involve a multidisciplinary team with the experience and resources to address the issue.
