RSNA 2017: Radiologic clues play key role in identifying domestic abuse, sexual assault

Radiologists could play a key role in identifying victims of domestic abuse and sexual assault, according to a study presented Nov. 27 at RSNA 2017 in Chicago.

When a young woman arrived at Brigham and Women’s Hospital in Boston with an acute nasal bone fracture superimposed on an older, healed fracture, her primary physician didn’t think twice about the injury’s origin. But when principal study investigator and radiologist Bharti Khurana, MD, examined the patient’s medical imaging records, she found something unexpected—a recent wrist fracture.

The pattern of recurrent injuries prompted Khurana to ask the woman about her domestic situation, eventually unraveling a story of intimate partner violence. The case inspired Khurana and colleagues’ study.

“This also led us to connect with some of our emergency department staff physicians and colleagues who were already working on the clinical and social aspects of this issue,” Khurana said in a press release. “We went on to design this research study to objectively assess the clinical and radiologic findings in this population.”

One in four American women are subject to domestic abuse, study author Elizabeth George, MD, said in the release, making the situation a public health problem she believes radiologists need to be aware of.

Khurana said that, as was the case with the young woman who arrived at the ER with a nasal bone fracture, older injuries are often overlooked in the rush to treat a patient’s current problem. Though the priority in the ER is to identify acute pathologies, she said, the issue with this is that overlooked older fractures or deformities can be clues of a pattern of violent behavior at home.

Khurana worked with George and others to review electronic medical records from patients referred to domestic abuse and sexual assault programs between January and October 2016.

“On the radiologic front, we identified common patterns of injury such as soft tissue injuries and extremity fractures, which often involved the distal upper extremities, suggesting injury from defensive attempts,” George said. “Other commonly seen injuries were facial fractures, which represent an easily accessible area for inflicting trauma. These injury patterns could alert the radiologists to potential intimate partner violence.”

Ninety-five percent of the 87 domestic abuse victims were women, according to the study, and typically in their 30s. The patients underwent a cumulative 665 radiology exams over five years, including x-rays, obstetric ultrasounds and musculoskeletal X-rays.

Of 35 sexual assault victims, 91 percent were female, Khurana et al. found. These women tended to be younger—the average age was 27.3 years—and black. More than a hundred radiology exams were performed on the cohort over five years, with the most popular being a chest X-ray. Head CT scans and pelvic ultrasounds were also abundant.

Domestic violence victims were more likely to be homeless, the research stated, while sexual assault victims were more likely to suffer from illicit drug abuse.

Khurana said radiologists could be important players in recognizing victims because of their access to extensive medical history databases and imaging knowledge.

“Our findings point toward the complex nature of these social situations and the need for a targeted intervention program not only to identify but also intervene in the various aspects of care of these patients,” she said.