Prevalence and Characteristics of Violence Against Persons at Parkland Hospital

BACKGROUND: Violence against persons (VAP) including interpersonal violence and human trafficking is a significant public health problem in the United States that affected 1.6% of the population in 2020. Systematic screening for VAP is inconsistent across hospital systems and often targets limited populations (i.e. pregnant women, homeless youth), resulting in inadequate broad detection of VAP. This study examined the prevalence of VAP and evaluated characteristics of VAP-positive patient encounters at a large safety-net hospital after implementation of an expanded screening program. METHODS: We conducted an analysis of the first six months of an expanded VAP screening program in the Emergency Department (ED) at Parkland Health and Hospital system from January to July 2021. The program involved: 1) a mixed four-question survey and observational procedure 2) strengthening referral pathways to Parkland's Victim Intervention Program/Rape Crisis Center (VIP), and 3) clinical education on VAP. A prospective chart analysis was conducted using Electronic Health Records (EHR) data for all patients who received the new screening. RESULTS: A total of 67,535 patient encounters were screened, out of which 1,349 (2.00%) were positive for VAP. On average, VAP positive patients were six years younger than VAP negative patients (38 vs 44 years respectively). VAP positive patients were more likely to be female (69.61%) than male (30.39%), and more likely to identify as Non-Hispanic Black (43.58%). VAP positive patients spent 28 less minutes in the ED in comparison to VAP-negative patients. The most prevalent VAP was physical abuse (71.76%), followed by psychological VAP (39.21%), observational signs VAP (37.06%), sexual VAP (31.36%), and control of food or money VAP (18.68%). The most referred VAP was physical with 48.33% of positive VAP encounters referred to VIP. CONCLUSIONS: Our results showed evidence of successful implementation of a broad screening program for VAP at a safety-net hospital. The rate of VAP identified in screening our population was greater than the national average. Furthermore, demographic data showed a higher prevalence of VAP in patients who are young, female, or Non-Hispanic Black, highlighting the need for further research on compounded effects of gender and race on VAP.