Radiologists must help spot abuse as domestic violence injuries rise during the pandemic

The ongoing pandemic has led to an increase in domestic violence injuries as large swaths of the workforce remain unemployed and forced to social distance indoors. And authors of a new study say it’s time for radiologists to step up and help identify these victims.

A team of doctors with Brigham and Women’s Hospital’s Trauma Imaging Research and Innovation Center compared instances, injuries and radiological findings in patients during the height of lockdown to reports during that same period over the past three years.

Overall, the number of people reporting intimate partner violence dropped during the pandemic, but the incidence of physical violence was 1.8 times greater during COVID-19. Injuries were also more severe—impacting internal organs—during 2020, the authors wrote Aug. 13 in Radiology.

“This indicates that victims are reporting to healthcare facilities in the late stages of the abuse cycle,” Bharti Khurana, MD, director of the Boston hospital’s trauma imaging center, said in a statement. “Fear of contracting infection and closure of ambulatory sites might be preventing victims of mild physical or emotional abuse from seeking help compared to the pre-pandemic era.”

Many healthcare providers were, or still are, overwhelmed by COVID-19, Khurana and colleagues wrote. They said that now is the “right moment” for radiologists to help identify victims of violence, and encouraged specialists to pay attention to imaging signs that may indicate IPV.

“By recognizing high imaging utilization, location and imaging patterns specific to IPV, old injuries of different body parts, and injuries inconsistent to provided history, radiologists can identify victims of IPV even when the victims are not forthcoming,” the team added.

For their results, four emergency radiologists looked at data from 26 victims of abuse reported between March 11 and May 3, along with 42 patients from 2017 to 2019. During the latter timeframe, there were 16 total injuries, compared to 28 in 2020.

Additionally, high-risk abuse, defined as using objects that could cause serious harm, was two times greater during the COVID-19 crisis.

Khurana et al. said healthcare providers are missing opportunities to earlier identify these victims. She again called on radiologists to help overburdened frontline workers and even suggested clinical risk factors for domestic abuse could be integrated into a clinical decision support tool to proactively detect cases. 

“With high risk physical abuse being highly associated with homicide, a smaller number of victims seeking medical care, and emergency medicine physicians overwhelmed with treating COVID-19 victims, radiologists should embrace the opportunity to provide patient-centered care by integrating longitudinal imaging data and providing early identification of victims,” they concluded.