Background: In Europe, it is estimated that one third of women had experienced at least one physical or sexual violence after their 15. Taking into account the severe health consequences, the Emergency Department (ED), may offer an opportunity to recognize when an aggression is part of the spectrum of violence. This study applies Social Network analysis (SNA) to ED data in the Lazio region with the objective to identify patterns of diagnoses, within all the ED accesses of women experiencing an aggression, that are signals for gender-based violence against women. We aim to develop a risk assessment tool for ED professionals in order to strength their ability to manage victims of violence.

Methods: A cohort of 124,691 women aged 15-70 with an ED visit for aggression between 2003 and 2015 was selected and, for each woman, the ED history of diagnoses and traumas was reconstructed. SNA was applied on all these diagnoses and traumas, including also 9 specific violence diagnoses. SNA community detection algorithms and network centrality measures were used to detect diagnostic patterns more strongly associated to violence. A logistic model was developed to validate the capability of these patterns to predict the odds for a woman of having an history of violence. Model results were summed up into a risk chart.

Results: Among women experiencing an aggression, SNA identified four communities representing specific violence-related patterns of diagnoses. Diagnoses having a central role in the violence network were alcohol or substance abuse, pregnancy-related conditions and psychoses. These high-risk violence related patterns accounted for at most 20% of our cohort. The logistic model had good predictive accuracy and predictive power confirming that diagnosis patterns identified through the SNA are meaningful in the violence recognition.

Conclusions: Routine ED data, analyzed using SNA, can be a first-line warning to recognize when an aggression related access is part of the spectrum of gender-based violence against women. Increasing the available number of predictors, such procedures may be proven to support ED staff in identifying early signs of violence to adequately support the victims and mitigate the harms.