Abstract Body: Introduction:
The incidence of domestic violence (DV) can vary from 2 to 4 million in a year. Domestic violence can be broad in definition and not limited to physical assault. The role of the medical provider in caring for these patients can be difficult; studies suggest that less than 10% of these cases are diagnosed correctly in the emergency room.
In collaboration with Brooklyn District Attorney office, we examined and designed a quality improvement study to look at the performance of CT imaging in non-fatal strangulation DV in the emergency department from 8/1/2021 to 3/31/2024 of all NYC Health and Hospitals System (NYCHH). The timely identification of arterial dissection can potentially lead to a decrease risk of stroke.

Methods:
We developed a non-fatal strangulation pathway in the emergency department for DV patients. We examined the use of CT head and CTA head and neck. The utilization of CT was monitored every quartile. Cases were abstracted with diagnoses of DV and asphyxiation. Strategies were employed to encourage and improve the utilization of pathway.

Results:
In total, 2163 domestic violence cases were abstracted from electronic medical records.
63% (n=1363) female
5.2% (113) male
31.7% (n=687) did not select for sex (NOA)
The percentage of CT performance during 8/1/2021 through 3/31/2024 was 5.5% (116/2163). Upon further evaluation, the percentage of female cases imaged was 5.5% (75/116); by contrast, male cases were imaged at 24.8% (28/116), and NOA 1.9% (13/116).
The odds ratio of CT performances in noted cases was 4.5 [95% CI 2.8016-7.2381], 13.0946 [6.5861-26.0349], 2.9 [1.6024-5.277], Male to female cases, male to NOA, and Female to NOA, respectively.

Discussion:
The literature on domestic violence range in incidence from 2 million to 4 million in a year. The identification of stroke risk factors from a domestic violence incident is a novel approach and has not been fully elucidated.
Non-fatal strangulation is known to decrease cerebral perfusion; the risk of developing an arterial dissection is known. Arterial dissection is an independent risk factor for ischemic stroke. In this study, we have observed a low utilization of imaging to rule out dissection; there is a suggestion of disparity among the sexes in diagnosis.

Conclusion:
The observation from this study involving all hospitals in the NYCHH system reveals a need to better educate and improve diagnosis of domestic violence. This can lead to prompt intervention and medical stabilization.