Boston Doctor Builds Tool To Identify Patients At Risk For Intimate Partner Violence

By Lisa Hughes, CBS Boston

October 18, 2024

BOSTON - Dr. Bharti Khurana, an Emergency Radiologist at Brigham and Women's Hospital was leaving a trauma "hackathon" in 2016 when a nurse practitioner began talking about Intimate Partner Violence. For all the advances in medicine, the NP told the group, there was little attention paid to the root cause of the injuries that sends many patients to the Emergency Department. Dr. Khurana stopped to listen. What she heard struck a chord. "I take it very personally. I'm an Emergency Radiologist. I'm a gatekeeper. I look at the imaging studies, decide if the patient should stay here and get admitted or discharged... For non-accidental trauma in children, we do such an excellent job. And then, when it comes to adults, we were not doing anything. So, I got motivated."

Dr. Khurana was already extolling the virtues of artificial intelligence, specifically in detecting fractures. While many radiologists viewed AI as a threat to their job security, she was eager to build a tool that would create an annotation for fractures even before radiologists looked at the images. But her focus began to shift as she wondered whether she could use AI to build a tool that would identify patients at risk for intimate partner violence. Six years later, she and her team (Dr. Khurana is the founder and director of the Trauma Imaging Research and Innovation Center) have done it. The tool, an automated clinical decision support tool for Intimate Partner Violence Risk and Severity Prevention (AIRS), uses radiological data and a patient's clinical history. "On average," she explains looking at an X-ray, "we can detect four years before the patient self-reports intimate partner violence." She explains that because domestic violence tends to escalate over time, knowing earlier can protect patients against more severe injuries. Its accuracy is now roughly 80%.

Obvious red flags include "target" and "defensive" injuries. An abuser's target is often the victim's head and face: orbital bones near the eye and cheekbones. Mid-facial fractures are, sadly, common in patients experiencing Intimate Partner Violence. Defensive injuries occur when patients try to protect themselves. Dr. Khurana explains that a broken forearm bone (ulna) near the pinky finger can be a sign that a patient has raised an arm to protect his or her face. By contrast, a broken arm bone (radius) near the thumb is common among patients who try to brace themselves for a fall. Radiological studies provided key data for the AIRS tool's creation. But it also includes so much more. Information in a patient's history (past ER visits, old fractures, medication, canceled screenings, etc.) that would take a long time for a busy radiologist to find and compile human being to compile is quickly gathered using the tool and provided-as an assessment-in real time while a healthcare provider reads the image.

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