Because domestic violence and assault on women often go undetected, clinicians are increasingly being called on to improve their recognition of abuse. Abuse-related injuries have been reported to occur most commonly on the central regions of the body, such as the head, neck or trunk, whereas unintentional injuries have been reported to commonly affect peripheral regions. Fanslow and associates conducted a retrospective study to determine whether women presenting to the emergency department after assault differed from those who presented with unintentional injuries.

The study was performed at the emergency departments of two hospitals in New Zealand. Each injury was classified as an assault, a suicide attempt or an unintentional injury. Identification of assault was based on the patient's self-report or on the staff's suspicion and subsequent documentation.

Of the 2,966 study participants who presented with an injury, 260 (8.8 percent) were identified as having sustained injuries as a result of assault, and 2,428 were identified as having unintentional injuries. The remaining 278 women (9.4 percent) presented after a suicide attempt and were excluded from analysis.

The relationship between the victim and the perpetrator was unspecified in 130 cases of assault (50 percent). In 82 of the remaining cases of assault (63 percent), the perpetrator was found to be the woman's partner or ex-partner. Women in the assault group tended to be younger (mean age: 30 years) than those in the unintentional injury group (mean age: 42 years). Women with injuries as a result of assault tended to present at night and on weekends, whereas those with unintentional injuries were more likely to present between 6 a.m. and 6 p.m. on any day of the week.

Women with injuries resulting from assault were 13 times more likely than those with unintentional injuries to have sustained injuries to the head. Women with assault-related injuries were three times more likely to present with contusions or ill-defined signs and symptoms, such as pain in the limb, as women with unintentional injuries. A higher proportion of the women in the assault group left the emergency department without receiving medical care (6.9 percent versus 2.1 percent).

The authors conclude that women seeking medical care after assault are younger, have different sites of injury and more frequently leave the medical facility before evaluation and treatment are completed. The predictive power of specific indicators, however, appears to be poor. Consequently, the authors urge health care professionals to screen for abuse in all women presenting to the emergency department.

In an editorial accompanying the article, Abbott supports the authors' observation that patterns of injury or trauma do not predict domestic violence with useful accuracy. Abbott urges clinicians to document an adequate history, but questions universal screening for domestic violence among all women presenting to the emergency department. Injured patients should certainly be asked what happened, and strategies should be developed to prevent future episodes.