Intimate Partner Violence Screenings, Physician Education Improve Referral Patterns

Researchers identify successful strategies to connect those affected by intimate partner violence to social work and law enforcement.

For effective intervention, targeted intimate partner violence (IPV) patient screenings with orbital and ocular injuries is essential, according to findings published in JAMA Ophthalmology.

Researchers conducted a retrospective quality improvement analysis to determine the number of IPV-associated orbital floor fractures, zygomaticomaxillary complex (ZMC) fractures, and ruptured globes referred to ancillary services in adult female patients following an educational screening intervention to health care professionals. The study examined the medical records of such patients seen in a single level 1 trauma center emergency department (ED) and ophthalmology clinic between 2015 and 2019, and data analysis occurred between May and September 2020. 

The study included a 2-part, ongoing intervention initiative that began in January 2015 in which, first, enhancement of IPV screening protocols in the ED was conducted, and second, the researchers presented an educational campaign to IPV injury patterns to residents and faculty in ophthalmology, emergency, otolaryngology, and trauma departments. The main outcome measure was a comparison of ancillary service involvement, preinitiative and postinitiative.

The researchers found that 216 patients sustained orbital floor or ZMC fractures postinitiative, and 10.2% of those patients (n=22) sustained fractures from IPV compared with 31 of 405 (7.6%) preinitiative (P =.28). In patients who presented after the initiative with orbital floor and ZMC fractures, documented social work referrals (P <.001), homegoing safety assessments (P <.001), and law enforcement involvement (P <.001) were higher. Finally, 51 patients sustained ruptured globes postinitative, 9.8% of whom (n=5) sustained injury due to IPB postinitiative, compared with 5 of 141 (3.5%) preinitiative (P =.08).

The researchers note that the present findings are in line with past studies, which have shown that emergency department electronic screening protocols increase the likelihood of discussion and disclosure of IPV and use of domestic violence services.

“Following the initiative, referral rates of patients with IPV associated orbital floor or ZMC fractures increased,” the study explains. “This combination of educational interventions and institutional changes has been shown to improve referral patterns of patients treated for IPV in the primary care setting.”

The study notes that its decision not to individually track physicians is a limitation since improvement cannot be directly attributed to this piece of the initiative.


Dawoud SA, Cohen AR, Renner LM, Clark TJ, Zimmerman MB, Shriver EM. Detection and referral of orbital and ocular injuries associated with intimate partner violence following an educational and screening initiative in an emergency department. JAMA Ophthalmol. Published online May 27, 2021. doi:10.1001/jamaophthalmol.2021.1546