A The Kids Research Institute Australia research student concerned by the types of injuries he was seeing in emergency departments as a trainee doctor has spearheaded an Australia-first study designed to help frontline workers better identify potential domestic violence cases and offer support to victims.
Dr Vishal Bulsara, who was a Masters student with The Kids and The University of Western Australia when he led the project, worked with researchers from the Institute, UWA and Notre Dame University to review 40 years’ worth of deidentified injury data for mothers presenting to WA hospitals between 1970 and 2013.
“We wanted to better understand the patterns of injury most often experienced by family and domestic violence victims, to help emergency staff better understand what they were seeing and ensure hospitals were in a position to provide appropriate and timely support,” Dr Bulsara said.
He said that while training as a doctor he had worked in a number of emergency departments and noticed frontline staff often had their hands tied in assisting suspected domestic victims.
“This was mainly because we couldn’t actually quantify what kind of injuries we should be looking out for, or which patients we should be asking whether they had experienced domestic violence,” Dr Bulsara said.
There wasn’t a great deal of published evidence out there about specific things to look out for – particularly not in a group like mothers. There have been a number of small studies but none looking at population-level data. This is the first attempt to understand FDV-related injury on a population level.
Working with senior author Associate Professor Melissa O’Donnell – a The Kids Research Institute Australia Honorary Research Fellow with more than a decade of experience in researching domestic violence and child protection data – Dr Bulsara analysed data associated with 11,546 FDV-related hospitalisations for 4,476 Western Australian mothers between 1970 and 2013.
Many of the mothers had had multiple hospitalisations – anywhere between one and 35 admissions – with the average being 3.1.
The review revealed the vast majority of injuries – 8,193, or 71 per cent – were to the head and/or neck region. The most common locations were the face and scalp, with the most common injuries to these areas being bruising, lacerations, cuts, abrasions and open wounds (7,079 admissions).
Fractures to the head – most commonly to the mandible (lower jaw), followed by the nose, maxilla (upper jaw), and orbital floor (eye socket) – represented 10 per cent of the injuries recorded (1,150 admissions for 454 mothers). Many women who had fractured jaws experienced the injury more than once (479 admissions for 144 mothers).
Consistent with existing evidence, Aboriginal mothers were over-represented (58.5% of admissions for FDV-related injuries) and had three times as many FDV injury-related hospital admissions than non-Aboriginal mothers. However, the researchers found that being Aboriginal did not increase the odds that a mother would suffer a head injury due to FDV.
The mean age of admission was 29 years and a total of 327 admissions occurred during pregnancy. The researchers found that mothers with younger children (under the age of 7 years, and particularly under the age of 12 months), and those with multiple children, were at higher risk of hospitalisation due to assault-related head injury than mothers with older children (aged 7-16 years) or only one child.
Dr O’Donnell, who is also Deputy Director for the Australian Centre for Child Protection, said that, critically, the researchers noted that the vast majority of the mothers (88.5% of those with a head injury and 72.6% of those without a head injury) typically spent only a very short time – less than 72 hours – in hospital.
“What this tells us is that frontline workers and hospitals have only a very limited window during which to identify family and domestic violence and to offer support and assistance for these mothers,” Dr O’Donnell said.
“They’re only in there for a couple of days, therefore hospitals have to have the resources available to connect women with services or arrange safety plans with them and their children.
The Women and Newborn Health Service has produced guidelines in responding to family and domestic violence and provides training for WA health staff, however hospitals need to ensure they have resources to get someone on the ward quickly to talk to the mother – otherwise they’re going to miss that narrow opportunity to offer assistance.
Dr O’Donnell said even though the data only covered the period up to 2013, evidence since then showed that if anything, the situation had become even worse.
“We know women are at increased risk because of the pandemic-related lockdowns we’ve had and that calls to domestic violence helplines have substantially risen– that means it’s even more important than ever that hospitals take a proactive approach,” she said.
Dr Bulsara – a former dentist who switched to medicine to specialise in Otolaryngology, Head and Neck surgery – said he hoped the findings would spark further research and provide a starting point for a simplified injury scoring tool that allowed emergency or primary care staff to risk-stratify patients and offer swift intervention.
“As has been recognised by the Australasian College for Emergency Medicine, we need to get much better as doctors, nurses and frontline workers at recognising domestic violence and quickly offering the right kind of help for people,” Dr Bulsara said.
“We need to do better and we need to do more, but we also need evidence so staff understand who and what they’re looking for, and so hospitals can provide the right kinds of resources.”
The full paper, Injuries in mothers hospitalised for domestic violence-related assault: a whole-population linked data study, can be read in BMJ Open.
Fast facts
- The Australian Institute of Health and Welfare (AIHW) defines FDV as ‘violence between family members, typically where the perpetrator exercises power and control over another person. The most common and pervasive instances occur in intimate (current or former) partner relationships and are usually referred to as domestic violence.’
- The World Health Organization estimates up to 30 per cent of women globally experience intimate partner violence in their lifetime.
- The AIHW estimates that during 2014–2015 in Australia almost eight women and two men required admission to hospitals in the country every day after being assaulted by their spouse or partner.
- Approximately one woman per week is killed as a result of violence from a current or previous partner.
- Australian Aboriginal and Torres Strait Islander women are 32 times more likely to be hospitalised due to FDV than non-Aboriginal women.
- In Australia, among women who had experienced violence by a partner, more than half (54%) had children in their care at the time of the violence.
- 68% of mothers said their children had heard or seen the violence.