Physical abuse of an adult is the use of force that causes injury or pain, most often by an intimate partner, a family member or a caregiver. Patients rarely say it on their own, so clinicians must notice the clues, ask in private and respond in a way that keeps the patient safe.
Key symptoms
- Injuries that do not match the story or a delay in seeking care
- Repeated visits for injuries, headaches or vague pain
- Anxiety, depression, sleep problems or substance use
- A partner or caregiver who answers for the patient and will not leave the room
- Missed appointments or medicines that are not taken
What you find on exam
- Interview the patient alone, with a professional interpreter if needed
- Bruises of different ages, on the face, neck, chest, breasts or forearms
- Pattern injuries: grip marks, bites, burns, marks from objects
- Signs of strangulation: neck bruises, hoarse voice, red spots in the eyes
- Document injuries with exact words, body maps and photos with consent
Tests
- X-rays or CT for suspected fractures or head injury
- CT angiography of the neck after strangulation with symptoms
- Pregnancy test in women of childbearing age
- Validated screening questions for intimate partner violence
Treatment basics
- Treat injuries and believe the patient without judging
- Safety assessment and a safety plan; offer advocacy and shelter resources
- Know local reporting laws; mandatory reporting applies to vulnerable and older adults
- Respect the choices of a competent adult and arrange follow-up
Red flags
- History of strangulation, which raises the risk of being killed
- Threats with a weapon or escalating violence
- Pregnancy, or a patient afraid to go home
Practice it in Making Synapses
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.