Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Kristen Nwanyanwu

Second Advisor

Christopher Teng

Abstract

Purpose: To investigate domestic violence-related ocular injuries among adult emergency department patients in the United States.

Methods: This was a retrospective, cross-sectional study of patients with a diagnosis of domestic violence and primary or secondary diagnosis of ocular injury in the Nationwide Emergency Department Sample (NEDS) from 2008-2017. We identified patient- and hospital-level variables associated with domestic violence-related ocular injuries. We calculated annual incidence rates using US Census data. Adjusting for inflation using the Consumer Price Index, we calculated mean and total charges.

Results: From 2008-2017, there were 26,215 emergency department visits related to domestic violence with an average incidence of 1.09 per 100,000 adult population (female patients, 84.5%; mean age [SE], 34.3 [0.2]). Domestic violence-related ocular injuries were most prevalent among patients in the lowest income quartile (39.1%) and on Medicaid (37.4%). Most emergency department visits presented to metropolitan teaching (55.4%), non-trauma (46.7%), and south regional (30.5%) hospitals. The most common ocular injury was contusion of eye/adnexa (61.1%). The hospital admission rate was 5.2% with a mean hospital stay of 2.9 [0.2]. Inflation-adjusted mean cost for medical services was $38,540 [2,310.8] with an average increase of $2,116 annually. The likelihood of hospital admission increased for patients aged ≥60 years old, on Medicare, and with a diagnosis of open globe or facial/orbital fractures (all p<0.05).

Conclusion: Contusion of the eye/adnexa was the most common ocular injury among patients with domestic violence-related emergency department visits. To better facilitate referrals to social services, ophthalmologists should target domestic violence screenings towards women and patients of less privileged socioeconomic status.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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