Forensic Nursing Examination to Screen for Traumatic Brain Injury Following Intimate Partner Violence and Strangulation

Abstract

Intimate partner violence (IPV) causes harm to an estimated 42 million victims each year. Routine forensic examination excludes specific evaluation of traumatic brain injury (TBI), thereby missing an opportunity to diagnose and offer treatment. This quality assurance/quality improvement project was designed to determine whether TBI signs and symptoms are detected in IPV patients using existing forensic nurse examination protocols. TBI signs and symptoms were cataloged from medical records to infer the incidence of TBI and inform an expansion of the nursing exam. Retrospective review of 19 cases collected over 31 days in June and July 2017 identified a predominance of young (average age 32.3), female (89.5%) patients with obstetric history (76.5% with 1 or more pregnancy), presenting with symptoms including lightheadedness / dizziness (84.2%), headache (78.9%), difficulty breathing (78.9%), and throat pain (68.4%). Subjective mechanism of injury included strangulation (100%), blow to the head with the perpetrator’s hand (52.6%), and fall to the ground (36.8%). TBI was not diagnosed during the exam, but recorded signs and symptoms indicated patterns consistent with brain injury. As a result of these findings, our team proposes expansion of the exam to include near point of convergence, balance, and hand-eye coordination testing to ensure detection of TBI signs in IPV victims. By detecting TBI signs early, community efforts can guide patients towards recovery, appropriate treatment options and successful return to society.