The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: a diagnostic accuracy study in general practice
The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: a diagnostic accuracy study in general practice
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DOI：
10.1186/1471-2296-8-49
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发表时间：
2007-08-29
影响因子：
2.9
通讯作者：
Feder, Gene
中科院分区：
文献类型：
--
作者：
Sohal, Hardip;Eldridge, Sandra;Feder, Gene
背景：亲密伴侣暴力（IPV）包括身体，性和情感暴力，导致短期和长期的健康不良。简单的问题，可靠地确定妇女经历IPV谁目前在临床环境中是一个先决条件，从卫生服务的适当反应，这一重大的公共卫生问题。我们估计的敏感性和特异性的四个问题（HARK）开发的滥用评估屏幕，相比，30项滥用问卷，复合滥用量表（CAS）。方法：我们管理的四个HARK问题和CAS的妇女接近两名研究人员在一般的做法等候室在纽汉，东伦敦。入选对象：17岁以上等待看医生或护士的女性，在过去一年中有过亲密关系。不包括：妇女谁是伴随着四岁以上的儿童或另一个成年人，太不适完成问卷调查，无法理解英语或无法给予知情同意。应答率为54%。在过去12个月内，使用CAS临界值>= 3，当前亲密伴侣暴力的发生率为23%（95% C.I. 17%至28%），测试前比值为0.3（95% CI。0.2 0.4）。受试者操作者特征曲线表明，>= 1的HARK截止分数使真阳性最大化，同时使假阳性最小化。最佳HARK临界值>= I的敏感性为81%（95% C.I. 69%至90%），特异性95%（95% C.I. 91%~ 98%），阳性预测值83%（95% C.I.阴性预测值94%（95% C.I. 90%~ 97%），似然比16（95%C. I.结论：HARK的四个问题准确地识别了在过去一年中经历IPV的妇女，并可能有助于妇女在一般实践中披露虐待。HARK问题可以被纳入初级保健的电子病历中，以提示临床医生询问最近的伴侣暴力行为，并鼓励患者披露。未来的研究应该测试HARK在临床咨询中的有效性。
Background: Intimate partner violence (IPV) including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that reliably identify women experiencing IPV who present in clinical settings are a pre-requisite for an appropriate response from health services to this substantial public health problem. We estimated the sensitivity and specificity of four questions ( HARK) developed from the Abuse Assessment screen, compared to a 30-item abuse questionnaire, the Composite Abuse Scale ( CAS).Methods: We administered the four HARK questions and the CAS to women approached by two researchers in general practice waiting rooms in Newham, east London. Inclusions: women aged more than 17 years waiting to see a doctor or nurse, who had been in an intimate relationship in the last year. Exclusions: women who were accompanied by children over four years of age or another adult, too unwell to complete the questionnaires, unable to understand English or unable to give informed consent.Results: Two hundred and thirty two women were recruited. The response rate was 54%. The prevalence of current intimate partner violence, within the last 12 months, using the CAS cut off score of >= 3, was 23% ( 95% C.I. 17% to 28%) with pre-test odds of 0.3 ( 95% C.I. 0.2 to 0.4). The receiver operator characteristic curve demonstrated that a HARK cut off score of >= I maximises the true positives whilst minimising the false positives. The sensitivity of the optimal HARK cut-off score of >= I was 81% ( 95% C.I. 69% to 90%), specificity 95% ( 95% C.I. 91% to 98%), positive predictive value 83% ( 95% C.I. 70% to 91%), negative predictive value 94% ( 95% C.I. 90% to 97%), likelihood ratio 16 ( 95% C. I. 8 to 31) and post-test odds 5.Conclusion: The four HARK questions accurately identify women experiencing IPV in the past year and may help women disclose abuse in general practice. The HARK questions could be incorporated into the electronic medical record in primary care to prompt clinicians to ask about recent partner violence and to encourage disclosure by patients. Future research should test the effectiveness of HARK in clinical consultations.