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Of the 491 women presenting to an emergency department during 48 computer-randomized, four-hour time blocks, Feldhaus and colleagues found 322 women to participate in a study designed to detect partner violence. They developed a partner violence screening (PVS) vehicle consisting of three questions, including: 1) Do you feel safe in your current relationship? 2) Is there a partner from a previous relationship who is making you feel unsafe now? and 3) Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? They asked those questions and recorded the responses verbally and then in writing. They then performed the Index of Spouse Abuse and the Conflict Tactic Scale (previously validated longer surveys of violence) and were able to statistically analyze the ability of the three questions to pick up partner violence.
They found that the overall prevalence rate of partner violence using the larger scale was 25-30%. When they compared these three questions to detecting partner abuse, they found the sensitivity was 64.5% and specificity was 80.3%.
The authors compared positive predictive and negative predictive values and found that the three brief questions of the PVS would detect 64.5-71.4% of the women who have a history of partner abuse.
Both the American College of Emergency Physicians (ACEP) and the American Academy of Family Physicians (AAFP) have independently called for increased awareness of domestic violence or family violence. Considering that current estimates of domestic violence include an annual incidence of about 1.4 million women, it’s about time. Men are not immune, with rates about 1% that of women, although they are not studied as well.
In addition to ACEP, the AAFP and AMA have developed continuing medical education and other educational experiences to help physicians recognize partner violence. The problem is, what can a busy practitioner do? The simple truth is that we don’t have time to question patients with the longer Index of Spouse Abuse or the Conflict Tactic Scale (CTS). But, I would argue with any clinician that they do have 20 seconds to ask three questions, especially ones with such gargantuan implications if any one of them is positive.
Actually, Feldhaus et al found that the one question that is probably the most indicative of a problem possibly occurring is: Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If responded to in the affirmative, the clinician should think about potential partner violence.
Noted in the comment section of that paper, they found that the highest incidence of partner violence was noted in women who had no current partner or had only a previous relationship to worry about. This actually reached 43% on the CTS. It is noted that their study did not look at marital rape.
Primary care physicians should initiate the three-question PVS and ascertain whether the patients in their practice are victims of domestic violence.