Using Policy to Strengthen the Reach and Impact of Injury Prevention Efforts

West J Emerg Med. 2011;12(3):268-270

The Emory Center for Injury Control: Vision and Priorities for Reducing Violence and Injuries through Interdisciplinary Collaborations

Injury is the leading cause of death in the United States for persons between the ages of 1 and 44 1. We see evidence of the scope and burden of injuries in the emergency department (ED), where annually an estimated 41.4 million patients are seen with injury-related visits, accounting for over one-third of ED presentations 2. While many disciplines are involved in injuryrelated research, prevention, and practice, emergency physicians are on the frontlines of this epidemic, and they treat patients with preventable injuries as well as those with the sequelae of violence. Emergency physicians are also in a unique position to prevent future injuries and to reduce the consequences of existing injuries especially through screening and brief interventions, and the use of a teachable moment for the benefit and future safety of their patients 2. It is because emergency medicine is so integrated and important for injury prevention and research 3 that we wante

Correlation Between Intimate Partner Violence Victimization and Risk of Substance Abuse and Depression among African-American Women in an Urban Emergency Department

Objective: To assess rates of substance abuse (including tobacco, alcohol, and drug abuse) as well as rates of intimate partner violence (IPV) among African-American women seen in an urban emergency department (ED). Methods: Eligible participants included all African-American women between the ages of 21-55 years old who were seen in an urban ED for any complaint and triaged to the waiting room. Eligible women who consented to participate completed a computer-based survey that focused on demographic information and general health questions, as well as standardized instruments to screen for alcohol abuse, tobacco abuse, and illicit drug use. This analysis uses results from a larger study evaluating the effects of providing patients with targeted educational literature based on the results of their screening. Results: Six-hundred ten women were surveyed; 430 women reported being in a relationship in the past year and among these, 85 women (20%) screened positive for IPV. Women who screened positive for IPV were significantly more likely to also screen positive for tobacco abuse (56 % vs. 37.5%, p< 0.001), alcohol abuse (47.1 % vs. 23.2%, p < 0.001), and drug abuse (44.7 % vs. 9.5%, p<0.001). Women who screened positive for IPV were also more likely to screen positive for depression and report social isolation. Conclusions: African-American women seen in the ED, who screen positive for IPV, are at significantly higher risk of drug, alcohol, tobacco abuse, depression and social isolation than women who do not screen positive for IPV. These findings have important implications for ED-based and community-based social services for women who are victims of intimate partner violence. [West J Emerg Med. 2010; 11(3): 252-256.

Missed Opportunities for Diagnosing HIV via Routine Screening in an Inner- City Primary Care Clinic

Background: Although routine, opt-out HIV screening has been recommended for nearly a decade, clinical practice has not kept pace. Here, we examine missed opportunities for HIV screening among patients newly diagnosed with HIV via a routine non-targeted opt-out HIV screening program in a primary care clinic at an inner-city safety-net hospital. Methods: Select demographic and clinical data were analyzed for all persons with a new HIV diagnosis between July 9, 2013 and August 31, 2015. Retrospective reviews of medical records were performed to identify missed opportunities for HIV screening in the year prior to HIV diagnosis. Results: Among 6,582 patients tested for HIV as part of the screening program, 27 patients had a new HIV diagnosis (0.41%). In the year prior to diagnosis, 19 (70%) of these had contact with the healthcare system but were not tested for HIV. At the visit associated with the new HIV diagnosis, 70% of patients did not present with an indication for risk-based HIV screening or symptoms potentially associated with HIV-related infections. Conclusions: Despite CDC recommendations for routine, non-targeted, opt-out HIV screening in all healthcare settings, 70% of patients newly diagnosed with HIV via routine screening in a primary care clinic had contact with the healthcare system in the year prior to the new HIV diagnosis but were not tested for HIV. These findings highlight the importance of routine, nontargeted screening to identify patients with HIV as well as continued provider and patient education about the value of routine HIV screening

Addressing Injuries in Vulnerable Populations: Research Collaborations and Partnerships

[West J Emerg Med. 2012;13(3):215-216.