Content area
Full Text
Domestic violence is an under-reported and major public health problem that often first presents to the accident and emergency (A&E) department. It accounts for half of all violent crimes against women, and two deaths per week have been linked to domestic violence in Britain. 1 Indeed, the Department of Health has issued statements to ensure health professionals are aware of domestic violence in this context when patients present with consistent traumatic injuries. 2
The following case report reflects the difficulties in diagnosing domestic violence in the A&E setting, and stresses the timely referral of such patients to the relevant authorities.
Case report
A 34 year old woman was brought to the A&E department by ambulance at 0400 hours with head injuries. When handed over from the ambulance crew an assault was queried, although the patient later stated she had fallen down stairs after moderate alcohol ingestion.
Her initial blood pressure was 119/72 mm Hg, pulse 88 beats/min, her pupils were equal and reactive directly and consensually, and her Glasgow coma score was 13/15 (she was confused and was opening her eyes to command). Examination of the head showed bilateral periorbital ecchymoses, nasal bridge swelling and epistaxis, a right frontal abrasion, and an occipital scalp haematoma. Ecchymoses were also noted on her back and buttocks, being linear in fashion on both upper arms, and her underpants were torn. Initial skull...