Radiologists can help break the destructive cycle of intimate partner violence by understanding the imaging patterns of lower extremity injuries indicative of such abuse, according to an investigation published Wednesday.
A team of East Coast imaging experts looked back on more than 80 victims of domestic violence who received imaging at a large academic medical center, sharing their findings in Emergency Radiology. Foot injuries were most common, accounting for 49% of all cases and nearly half of all fractures.
But what radiologists really should look out for, the authors wrote, are recurrent patterns, as nearly three-quarters of patients with recurrent injuries suffered foot and ankle damage. Such trauma commonly occurs as victims attempt to protect themselves, leaving their lower legs and upper limbs vulnerable to attack.
“Once radiologists are able to recognize emerging injury patterns related to intimate partner violence [IPV] such as soft tissue injuries to the face; fractures of the nose…and repetitive soft tissue injuries or fractures involving the feet or ankle or forearm or hands, they can facilitate early identification of IPV and in turn save lives by breaking the cycle of violence,” first author Babina Gosangi, MD, of Yale New Haven Health System, and colleagues wrote.
What to look out for
The organization’s domestic violence program provided a list of 1,248 patients who reported partner abuse between June 2013-2018. Overall, 88 victims with 154 injuries were used in the study, including 15 men and 73 women.
- Fractures were the most common (103 findings), followed by soft tissue injuries (46) and 5 dislocations.
- Most damages were spotted in the foot, representing 39% of all injuries, 48% of fractures, 17% of soft tissue damages and three dislocations. Metatarsals accounted for 22% of fractures, followed by toe bones in 16% of cases.
- The ankle was the second most common site of trauma, responsible for 30% of all injuries, 20% of fractures, and 57% of soft tissue damage.
- The group identified 74 recurrent injuries in 26 victims. Again, most occurred in the foot and ankle (72%), yielding 12 ankle fractures, 13 metatarsal fractures, and 10 phalangeal fractures, among others.
- Subsequent visits to the emergency department led to a greater number and more severe injuries, the authors found. They often included nasal fractures, mandibular fractures, orbital fractures, and intracranial hemorrhages.
What can radiology departments do?
First of all, the authors noted, recurrent foot and ankle injuries and associated upper extremity trauma in women under 35 should raise rads’ suspicion of intimate partner violence. This is particularly true if a patient’s clinical history doesn’t align with their imaging injuries.
Aside from increased awareness, rads can alert clinical team members about possible abuse with a direct phone call, Gosangi et al. suggested. And technologists can ask the patient if they’re suffering abuse during their exam when the partner has stepped out to avoid radiation exposure.
“Radiologists can play a significant role in the identification of IPV, similar to their role in identifying non-accidental trauma in children,” the team concluded. “Knowledge and awareness of the patterns will aid radiologists in potentially saving lives by improving the identification of IPV.”
Read the entire study published Feb. 24 here.