Sex-Based Differences in Injury Patterns and Hospitalization from Emergency Department Narratives of Intimate Partner Violence, United States, 2013–2024

Background: Billing codes often underestimate the prevalence of intimate partner violence (IPV)- related injuries in Emergency Department (ED) visits, because they are not specific to IPV. Limited data exists on how EDs address IPV, especially the documentation of IPV incidents in patient records. Methods: We analyzed NEISS data from 2013–2024, identifying IPV cases through a systematic review of narrative text using a rule-based natural language processing approach. All cases involving detected IPV were included, whether the patient’s injury resulted from direct victimization or object-directed aggression. Survey weights generated national estimates, and logistic regression models assessed demographic predictors of head/neck injuries and hospital admissions. Results: From 2013–2024, an estimated 41,214 IPV-related ED visits occurred nationally (mean = 3,400; .025%). Fractures occurred in 12.2% (5,029) of incidents, commonly involving the upper extremities; head/neck fractures were less frequent but more severe. Males accounted for the majority of extremity injuries; females were disproportionately represented among head/neck fractures. Adults over the age of 45 had over fivefold higher odds of hospital admission compared to persons under 30. Alcohol involvement was associated with a 70% increase in the odds of head/neck injury, and differences were observed by patient sex. Narrative review indicated that females’ injuries frequently occurred in defensive or self-directed contexts, whereas males’ injuries more often reflected object-directed aggression and commonly co-occurred with alcohol use. Conclusion: Narrative-based surveillance of ED event descriptions captures IPV-related visits regardless of who was injured and can be used to inform ED screenings, safety planning, and targeted prevention.