Need for TBI testing in standard forensic nursing exams

This content was originally authored by Katie Taylor for the 10/31/19 edition of our Weekly Concussion Update newsletter.

An article published by EurekAlert! discussed the possibility of improving care for victims of domestic violence. Currently, patients are not tested for traumatic brain injuries in forensic nursing exams following domestic violence, strangulation, or rape. However, according to a study in the Journal of Aggression, Maltreatment & Trauma conducted by Bridget Ralston et al. from the University of Arizona, testing for TBIs could help victims seek and receive proper medical care.

Because domestic violence cases often present pressing orthopedic injuries, potential brain trauma may be overlooked, especially in the emergency department. From a retrospective review of 19 patient cases, Bridget Ralston et al. found that clinical signs of brain injury were recorded in 100% of cases involving strangulation, 52.6% of cases involving head blows, and 36.8% of cases involving falls but that no diagnoses of TBI were made. Jonathan Lifshitz, one of the contributors in this study and director of the Translational Neurotrauma Research Program at the University of Arizona College of Medicine, emphasized that “Health-care professionals across disciplines have rarely, if ever, considered domestic violence and intimate partner violence as a cause for TBI.”

Because TBIs, left untreated, can lead to disabling long-term consequences, forensic nursing exams that fail to test for brain injury could hinder full recovery from trauma and put patients at increased risk for long-term neurological symptoms. Bridget Ralston et al. recommend the addition of neurologic tests to standard forensic nursing exams to improve the lives and outcomes of trauma survivors and to expand the discussion surrounding domestic violence.