Intimate Partner or Domestic Violence-Related Traumatic Brain Injury in the United States from 2018 to 2021: A National Trauma Data Bank Analysis of 3,891 Patients

Introduction: Despite substantial medical and socio-legal consequences of traumatic brain injury (TBI) from intimate partner and domestic violence (IPV/DV), understanding of its incidence, risk factors, and outcomes remains lacking. Our study investigated these variables in United States (US) IPV/DV patients with and without TBI (IPV/DV-TBI; non-TBI) using the National Trauma Data Bank (NTDB).

Methods: NTDB Trauma Quality Programs Participant Use Files (years 2018-2021) were queried for adults (age ≥18-years) with IPV/DV-related trauma, using International Classification of Diseases, Tenth Revision external cause codes. Primary diagnoses were classified as TBI/non-TBI using diagnosis codes. Age, sex, race/ethnicity, insurance payor, hospital length of stay (HLOS), discharge disposition, and perpetrator data were extracted. Statistical differences were evaluated with Welch’s t-test and Pearson’s chi-squared test using post-hoc Bonferroni-corrected residual analysis (significance: p≤0.05).

Results: In 3,891 IPV/DV-related cases, 74.1% were perpetrated by partners. Of 1,212 (31.1%) TBI cases, 84.7% were mild (Glasgow Coma Scale (GCS)=13-15). A smaller subset (7.4%) had severe TBI (GCS=3-8), with 48.9% admitted to intensive care unit (ICU) and 26.7% mortality. The most prevalent TBI types were skull fracture (26.1%), concussion (24.9%), subdural (19.0%) and subarachnoid hemorrhage (12.2%). The IPV/DV-TBI group had more female (TBI/non-TBI: 77.2%/64.6%, p< 0.001) and fewer Black patients (28.9%/36.6%, p< 0.001), more ICU admissions (20.9%/7.5%, p< 0.001), longer HLOS (5.3±9.5-days/4.5±6.4-days, p=0.008) and higher mortality (4.1%/1.8%, p< 0.001). Discharge to home did not differ significantly between IPV/DV-TBI and non-TBI (7.3%/9.9%, p=0.070).

Conclusion : A significant proportion of IPV/DV trauma patients suffered neurological injury, with mostly partner-perpetrated assault and a high proportion of females. Though the TBI group had a lower proportion of Black patients, representation of racial minorities was elevated in both groups compared to US census estimates. While most injuries were “mild,” the increased need for ICU care, longer HLOS, and elevated mortality among subsets of IPV/DV-TBI patients underscore the complex morbidities incurred and socio-medical resources needed to care for this population vulnerable to recurrent trauma. Elucidating victims’ barriers to seeking care and improving clinical screening constitute relevant next steps.