Epidemiology of Intimate Partner and Domestic Violence-Related Traumatic Brain Injury in the United States

Neurology Clinical Psychology Neurosurgery Environmental and Public Health Medicine
injury brain injury epidemiology domestic violence intimate partner violence

Epidemiological Study of Intimate Partner and Domestic Violence-Related Traumatic Brain Injuries in the United States from 2018-2021

Background

Intimate partner violence (IPV) and domestic violence (DV) have severe medical, social, and legal consequences for victims. These violent events often result in traumatic brain injuries (TBIs), further exacerbating the suffering of victims. However, little is known about the incidence and acute outcomes of IPV/DV-related TBIs.

This study utilized the National Trauma Data Bank (NTDB) in the United States, aiming to (1) describe the incidence, demographics, clinical characteristics, and hospitalization outcomes of patients with IPV/DV-related trauma complicated by TBI (IPV/DV-TBI) and without TBI (IPV/DV non-TBI) from 2018-2021; (2) compare the differences between IPV/DV-TBI and non-TBI patients. The researchers hypothesized that IPV/DV-TBI patients would have higher incidence and mortality rates during hospitalization.

Research Source

This study was conducted by researchers from the Department of Neurological Surgery, Brain and Spinal Injury Center, Weill Institute for Neurosciences, and Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, and published in the journal Neurosurgery in 2024.

Research Process and Methods

The researchers utilized the 2018-2021 NTDB data, screening for IPV/DV-related trauma patients aged ≥18 years, and categorizing them into IPV/DV-TBI and IPV/DV non-TBI groups based on ICD-10 codes.

For IPV/DV-TBI patients, the researchers recorded the following details: a) TBI severity, types of intracranial injuries (e.g., skull fractures, subdural hematomas, etc.), and their numbers; b) Age, gender, race, insurance status; c) Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) scores; d) Length of stay, intensive care unit (ICU) admission rate, discharge disposition, in-hospital mortality rate.

The researchers employed various statistical methods to compare the differences between the two groups and performed multivariate regression analyses to evaluate the association between TBI and outcome measures.

Key Findings

  1. Among 3,891 IPV/DV-related trauma cases, 31.1% were complicated by TBI. Intracranial injuries included skull fractures (30.2%), subdural hematomas (19.8%), subarachnoid hemorrhages (13.4%), epidural hematomas (1.1%), brain contusions (8.1%), and cerebral edema (3.3%).

  2. Among IPV/DV-TBI patients, 87.4% had mild TBI, 4.3% had moderate TBI, and 8.3% had severe TBI. Patients with severe TBI had the longest length of stay (11.5 days) and the highest mortality rate (28.6%).

  3. Compared to IPV/DV non-TBI patients, IPV/DV-TBI patients had higher proportions of females (77.2% vs. 64.6%) and whites (55.1% vs. 49.2%), but a lower proportion of blacks (28.9% vs. 36.6%).

  4. IPV/DV-TBI patients had higher ISS scores (11.0 vs. 6.1), higher head and face AIS scores. They were more likely to be admitted to the ICU (20.9% vs. 7.5%), had longer lengths of stay (5.3 days vs. 4.5 days), lower rates of discharge to home (79.8% vs. 83.8%), and higher mortality rates (4.1% vs. 1.8%).

  5. Multivariate regression analysis confirmed that, compared to non-TBI patients, TBI patients had an odds ratio of 4.29 for ICU admission, a hazard ratio of 3.20 for mortality, an additional 1.22 days of hospitalization, and an odds ratio of 0.57 for discharge to home.

Research Significance

This study revealed that approximately one-third of IPV/DV-related trauma cases in the United States were complicated by TBI, predominantly involving females and blacks. IPV/DV-TBI patients faced higher rates of morbidity and mortality during hospitalization and had lower chances of being discharged home.

The researchers called for enhanced risk factor assessment and social-medical resource interventions for this high-risk population to improve their care quality. Additionally, the unique challenges faced by minority groups like blacks in IPV/DV and TBI should be explored to promote health equity.

It is notable that many mild TBI patients, although having less severe conditions, may be at higher risk for long-term complications due to potential repeated trauma. Therefore, regardless of TBI severity, IPV/DV victims presenting to the emergency department should be appropriately screened, evaluated, and intervened.