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Brief Report
May 27, 2021

Detection and Referral of Orbital and Ocular Injuries Associated With Intimate Partner Violence Following an Educational and Screening Initiative in an Emergency Department

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
  • 2Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky
  • 3University of Minnesota School of Social Work, St Paul
  • 4Eye Surgeon Associates, Lincoln, Nebraska
  • 5Department of Biostatistics, University of Iowa, Iowa City
JAMA Ophthalmol. 2021;139(7):785-789. doi:10.1001/jamaophthalmol.2021.1546
Key Points

Question  Is an intimate partner violence (IPV) educational campaign with standardization of emergency department screening protocols associated with improved referral of patients with IPV-associated orbital fractures and ruptured globes to social work and law enforcement?

Findings  This quality improvement analysis revealed an increase in referral of patients with IPV-associated orbital floor or zygomaticomaxillary complex fractures to social work and law enforcement following an education and screening initiative.

Meaning  These findings suggest the combination of an educational campaign on IPV injury patterns and enhanced emergency department screening protocols can improve referral patterns of patients affected by IPV and may potentially be lifesaving.


Importance  Intimate partner violence (IPV) is a substantial cause of morbidity and mortality in the US. Previous studies indicate gaps in identifying and referring female patients with IPV-associated orbital and ocular injuries to ancillary services.

Objective  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 and screening intervention to health care professionals.

Design, Setting, and Participants  This single-center retrospective quality improvement analysis examined electronic medical records of adult female patients seen in a single level 1 trauma center emergency department and ophthalmology clinic between January 2015 and February 2019, after the initiative began. Female adults who sustained orbital floor fractures, ZMC fractures, or ruptured globes were included. Preinitiative data were previously collected between January 1995 and January 2015 on adult female patients and published. Data analysis for this study occurred from May 2020 to September 2020.

Interventions  A 2-part, ongoing initiative began January 2015. First, enhancement of IPV screening protocols in the emergency department was conducted. Second, an educational campaign on IPV injury patterns was presented to residents and faculty in ophthalmology, emergency, otolaryngology, and trauma departments.

Main Outcomes and Measures  Comparison of ancillary service involvement preinitiative (January 1995 to January 2015) and postinitiative (January 2015 to February 2019).

Results  A total of 216 adult female patients (mean [SD] age, 55.0 [22.7] years; age range, 18-99 years) sustained orbital floor or ZMC fractures postinitiative. A total of 22 of 216 (10.2%) sustained fractures from IPV compared with 31 of 405 (7.6%) preinitiative (95% CI, −2.2% to 7.3%; P = .28). Documented social work referrals (11 of 31 preinitiative vs 20 of 22 postinitiative; difference, 55% [95% CI, 35%-76%]; P < .001), homegoing safety assessments (1 of 31 preinitiative vs 18 of 22 postinitiative; difference, 79% [95% CI, 61%-96%]; P < .001), and law enforcement involvement (7 of 21 preinitiative vs 16 of 22 postinitiative; difference, 50% [95% CI, 26%-74%]; P < .001) were higher in patients who presented after the initiative with orbital floor and ZMC fractures. A total of 51 adult female patients (mean [SD] age, 57.7 [20.8] years; age range 20-93 years) sustained ruptured globes postinitiative. A total of 5 of 51 patients (9.8%) sustained injury due to IPV postinitiative, compared with 5 of 141 (3.5%) preinitiative (95% patients, −2.5% to 15.0%; P = .08).

Conclusions and Relevance  Following the start of the initiative, referral patterns of adult female patients with IPV-associated orbital fractures improved. Targeted IPV screening of patients with orbital and ocular injuries is essential for effective intervention.

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