Violence against women is a major public-health problem, with death being the most severe consequence [1], and the home becoming the most dangerous place for women [2]. In 2017, a total of 87,000 women were intentionally murdered worldwide, around 30,000 of them were murdered by their current or former intimate partner [3]. The proportion of homicides by an intimate partner is six times higher for female than for male homicides [4]. The lifetime prevalence of physical intimate partner violence (IPV) ranges from 13 to 61%, as estimated by the World Health Organisation (WHO) [5]. In Iceland, the lifetime prevalence of IPV has been estimated at 22% [6]. According to WHO, violence can be divided into IPV and community violence (CV), which is perpetrated by an acquaintance or a stranger [7].

IPV negatively affects women’s health in a variety of domains. A case-control study found that abused women visited their GP almost twice more often than non-abused women, and were prescribed anti-depressant medication 4.1 times more often than non-abused women [8]. Compared to women exposed to community violence, those exposed to IPV are more likely to experience various long-term psychological consequences, such as depression, anxiety, panic attacks, loss of self-confidence and a feeling of vulnerability [9]. IPV abuse contributes to significantly higher mental-health service utilization compared to never-abused women [10], and women subjected to IPV are more likely to have suicidal ideation and suicidal behaviour [11], post-traumatic stress disorder (PTSD) and anxiety [12] than non-abused women.

Abuse increases women’s health care utilization, such as primary and emergency care, speciality services and hospital admissions [13]. Findings show that the hospital admission ratio is approximately 3–5% amongst IPV patients [14], [15], and a U.S. study revealed that around a third of all of women’s assault-related emergency visits were a consequence of IPV [16]. Studies indicate that women with a history of physical IPV use the Emergency Department (ED) significantly more [15], [17], and have significantly lower health status ratings, than non-abused women [18]. They experience repeated violent episodes, with up to 70% of women visiting the ED due to IPV reporting that the abuse was not the first episode [19]. They also interact more frequently with health care workers than do non-abused women [20]. A recent Icelandic study on women’s IPV-related visits to the ED found that 38% of women made repeated visits to the hospital due to new injuries resulting from IPV [15].

Research has shown that female survivors of CV are more likely than IPV survivors to be attacked by more than one perpetrator and at various locations, such as on the street, or in public places [21]. On the other hand, IPV survivors are more likely to be attacked by a single perpetrator in a private environment, such as their place of residence, that of the perpetrator, or a residence they share [21].

Studies comparing the nature of IPV and non-IPV injuries found head, neck and face injuries (HNF) to be the most common location of IPV-related injuries [19], [22], [23]. Of upper extremity injuries, hand and finger injuries are the most common among IPV survivors [24]. According to a 2019 study, survivors of family violence (of whom 90% were IPV cases) sustained significantly more physical injuries and were more likely to be injured at almost every bodily location, as opposed to survivors of non-family violence [25]. Injuries located on the thorax, abdomen and pelvic area are considered non-specific IPV injuries [26]. The most common types of injuries resulting from IPV are superficial injuries, contusions, and lacerations of minor traumatic level [14], [15], [22], such as small hematomas, small abrasions, or large bruises [23]. According to a Dutch study on survivors of IPV and CV, women subjected to IPV were more likely to have bruises, swellings, redness, soft tissue lesions and bite wounds, whereas CV survivors were more likely to have abrasions, lacerations, and fractures [21].

More research is needed to improve the identification of characteristics for IPV within healthcare settings [27]. It is crucial for health care professionals to be given the tools to be able to efficiently identify IPV in an effort to avoid future health problems for IPV survivors, as well as further injuries and more frequent ED visits [28]. IPV is a widespread, but often unidentified health concern [16]. It is underreported and hidden, as women might be reluctant to disclose and discuss the abuse, which makes its identification even more difficult [29].

The purpose of our study is to find and compare distinguishing characteristics between women’s violence inflicted physical injuries, as presented in Iceland’s largest ED. Our results can be used to increase identification of IPV within health care settings, resulting in more holistic care for survivors, less injuries, and fewer ED visits in the hope to prevent future health problems. To our knowledge, this is the first study to use medical records on such an extensive scale to compare the nature of women’s violence-inflicted physical injuries and their ED visits.