July 2009 Mechanism of Injury and Population Predictors of Sexual Assault and Domestic Violence Background  There are over 4 million reported instances of domestic violence annually in the United States Methods Results Discussion Michelle Fakler, Miami University, 4 th year undergraduate student Emergency Medicine Research, Summa Health System Sheila Steer, M.D. P# 12  Study design: Retrospective Chart Review  Medical records are handwritten and stored in the DOVE unit  Patient identity was keyed to maintain anonymity; this key is kept in the DOVE unit at all times  All chart review occurred at St. Thomas hospital  An access database consisting of 474 instances of Domestic Violence was constructed  Stata Software was used to analyze the data Self-Inflicted scratches Strangulation Demo Ligature Marks Petechiae Subconjunctival Hemmorrhage What is DOVE? DOVE (Developing Options for Violent Emergencies) provides specialized healthcare for victims of acute sexual assault, domestic violence, and elder abuse and neglect. DOVE clinicians provide medico-legal care to these patients, collect physical evidence, and provide expert testimony when needed. 38.9% of Domestic Violence Patients were strangled. Adapted from D. Hawley MD: Death by Strangulation  Strangulation, a form of asphyxia characterized by closure of the blood vessels and air passages of the neck as a result of external pressure on the neck 2, is a common mechanism of injury  Death may occur after 4-5 minutes of pressure 1  Lethality risk refers to assessment of a domestic violence victim’s risk of dying from the current situation  These factors impact lethality: the presence of a firearm in the home 7,8, threats of suicide/homicide by the abusive partner 8, significant bodily injury, and suffering from a significant strangulation episode  The aims of this research are to document the prevalence of strangulation in SUMMA DOVE population from and to assess lethality risk in this domestic violence population  Only approximately 50% of strangulation victims present with visible injuries 2,3,4  Some studies cite incidence rates of % of victims reporting a history of abuse 5,6 Exact anatomic location of applied force Duration of applied force Quantity of applied force Surface area of applied force 95.11% of strangulation victims were manually strangled 6 Glass, N., Laughon, K., Campbell, J., Block, C.R., Hanson, G., & Sharps, P.W., Taliaferro, E. (2008). Non-fatal strangulation is an important risk factor for homocide of women. Journal of Emergency Medicine, 35, Sorenson, S.B. (2006).Firearm use in intimate partner violence: A brief overview. Evaluation Review, 30, Sorenson, S.B., & Wiebe, D.J. (2004). Weapons in the lives of battered women. American Journal of Public Health, 94, Coker, A.L. (2006).Preventing intimate vartner violence: How we will rise to the challenge. American Journal of Preventative Medicine, 30, Woods, S.J., Hall, R.J., Campbell, J.C., & Angott, D.M. (2008). Physical health and posttraumatic stress disorder symptoms in women experiencing intimate partner violence. Journal of Midwifery and Women's Health, 53, Smith, D.J., Mills, T., & Taliaferro, E.H. (2001). Frequency and relationship of reported symptomatology in victims of intimate partner violence: The effect of multiple strangulation attacks. Journal of Emergency Medicine, 21, Jennifer Markowitz: Presentation 3 Hawley, D.A., McClane, G.E., & Strack, G.B. (2001). A review of 300 attempted strangulation cases part III: Injuries in fatal cases. Journal of Emergency Medicine, 21, Strack, G.B., McClane, G.E., & Hawley, D. (2001). A review of 300 attempted strangulation cases part I: Criminal legal issues. Journal of Emergency Medicine, 21, Sheridan, D.J., & Nash, K.R. (2007). Acute injury patterns of intimate partner violence victims. Trauma, Violence, & Abuse, 8,  Over the years , the DOVE Program forensic nurses saw an average of 127 domestic violence patients per year  In 2008 alone, 1576 cases of domestic aggravated assault, battery, and verbal assault were reported to the Akron Police Department; therefore, the statistics concerning this healthcare-seeking population may pertain to a subpopulation suffering from particularly brutal assault