How to manage a woman presenting with bruises, suspected to be a victim of abuse?

Management of a Woman Presenting with Bruises Suspected to be from Abuse

When a woman presents with bruises suspected to be from abuse, the healthcare provider should immediately contact social services while simultaneously providing medical care and documentation of injuries. 1

Initial Assessment

Physical Examination

• Document all bruises thoroughly, noting:
  • Location, size, shape, and color
  • Any patterned bruises (may indicate specific objects used)
  • Hand or finger marks that suggest grabbing or squeezing 2
  • Distribution (bruises on face, neck, trunk, or ears are particularly concerning for abuse)

Medical Evaluation

• Rule out medical causes of bruising:
  • Bleeding disorders (coagulation factor deficiencies, von Willebrand disease)
  • Platelet disorders
  • Vitamin K deficiency
  • Medication effects (anticoagulants)

Psychosocial Assessment

• Conduct a private interview without the potential abuser present
• Use open-ended questions about how injuries occurred
• Note discrepancies between the explanation and the pattern/severity of injuries
• Assess for risk factors including:
  • Previous incidents of violence
  • Escalation of abuse
  • Threats from partner
  • Access to weapons

Documentation and Evidence Collection

• Take high-quality photographs of all visible injuries with a scale marker
• Consider using alternate light sources to detect bruises not visible under normal lighting 3
• Document the patient's own words regarding how injuries occurred
• Record any inconsistencies between the explanation and injury patterns
• Use body diagrams to mark locations of all injuries

Intervention Protocol

1. Ensure immediate safety

   • Determine if the patient can safely return to her residence
   • Discuss safety planning if she chooses to return to a potentially dangerous situation

2. Contact social services immediately 1

   • This is the most appropriate first action to connect the patient with resources
   • Social services can help coordinate:
     • Emergency shelter options
     • Legal advocacy
     • Ongoing support services
     • Safety planning

3. Provide medical care for injuries

   • Treat any acute medical needs
   • Consider imaging if there's concern for deeper injuries

4. Offer resources

   • Provide information about local domestic violence shelters
   • Share hotline numbers
   • Connect with advocacy services

Legal Considerations

• Inform the patient about mandatory reporting requirements in your jurisdiction
• Documentation may be used in legal proceedings
• A police report may be necessary depending on:
  • Severity of injuries
  • Local laws regarding domestic violence
  • Patient's wishes (when reporting is not mandatory)

Common Pitfalls to Avoid

• Failing to screen for abuse: Don't assume bruises are accidental without thorough assessment
• Missing medical causes: Consider bleeding disorders when bruising patterns are atypical 4
• Inadequate documentation: Poor documentation can hamper legal proceedings
• Violating privacy: Never discuss findings with accompanying individuals who may be perpetrators
• Rushing the process: Victims need time and support to make decisions about their safety

Follow-up Care

• Schedule a follow-up appointment to monitor healing and provide continued support
• Coordinate with social services for ongoing case management 5
• Consider referral for trauma-focused therapy if appropriate 1

By following this approach, healthcare providers can effectively address both the medical and social needs of women presenting with bruises suspected to be from abuse, prioritizing their safety and well-being.