Reviewer’s report
Title: 
Interplay between Traumatic Brain Injury and Intimate Partner Violence:
Data Driven Analysis Utilizing Electronic Health Records
Version: 
0 
Date: 
02 Mar 2020
Reviewer's report:
OVERALL: There are important findings here, but I find the article is very
focused on the analysis, rather than the substantive importance. The article lacks
a "so what now" factor—now that we know these terms are associated with
TBI+IPV, how will it change the practice of a health care provider? Also, the
integration of IPV literature, knowledge, and wording to describe IPV is lacking
throughout. I would like to see a more nuanced representation of IPV and
additional subject matter expertise of an IPV researcher. There are several
instances where familiarity of the topic is lacking. This is concerning given
critiques that AI/machine learning algorithms can perpetuate bias, and my worry
is that the significance of the authors' findings are merely computer generated
and lack impact to the IPV field. Also, there is virtually no discussion on
homicide risk and strangulation, which are important potential outcomes of TBI,
IPV and TBI+IPV. 
INTRO: 
In full para before Objective—sounds like the onus is on victims to disclose, but
equally important is that medical providers are reluctant to screen for IPV and
victims' & providers' unaware that IPV hits to the head/strangulation can result
in TBI—like authors said, TBI screening is done more routinely for
environmental trauma, sports, etc. See Banks, 2007; CDC, 2015 
Also missing the links between strangulation and TBI. See Drew & Drew, 2004;
Sauvageau & Boghossian, 2010; Murray, Lundgren, Olson, & Hunnicutt, 2016 
OBJECTIVE
Line 37-38--- Who is the third party and what is their expertise? Is the person an
IPV and TBI expert? Is this an expert in asking the questions in EMR?
METHODS/CONTROL COHROTS—
This very clunky sentence needs to be revised: …since violence against a woman
at home can indeed cause failing off stairs. 
DATA ANALYSIS
Articulate the significance of the finding that falling off stairs shares more terms
with IPV than IPV+TBI (second to last full para in RESULTS, last sentence). Is
this confirming your hypothesis? Seems like of some this is discussed in last full
para in RESULTS section, but they way it is written, it is not clear what the
significance of the finding is.
The results section on synergistically significant terms is written clearly, but it
the significance is not clear. So, there is some relationship between gallstones
and IPV because there were 38 synergistic terms, and failing off stairs is less
associated with IPV because there were only 22 synergistic terms? This seems to
show an issue with the algorithm and should be explained more, with literature
as evidence, in the discussion. 
DISCUSSION
Alcohol consumption is also a coping method to deal with IPV, not just a
vulnerability factor. Some of the language throughout suggests causal language,
when a lot of these relationships are correlates. 
In limitations—there needs to be more integration of IPV literature. Not only do
healthcare providers infrequently use ICD codes for DV, victims who don't trust
providers will not tell their provider they are victims of abuse, and the study's
algorithms is not catching all the cases. How does this limitation affect the
results? 
I would like a stronger discussion and recommendations—authors say that using
EHR databases can open up new perspectives, find new patterns, and health
effects overlooked—can the authors make some stronger recommendations
about a constellation of symptoms that a healthcare observe that should
necessitate further treatment or assessment, for TBI or IPV? The article lacks a
"so what now" factor—now that I know these terms are associated with
TBI+IPV, how will it change my practice as a health care provider. 
OTHER POINTS TO CONSIDER—
There are legal implications of having IPV reported in EMR (could it be used
against in her court, does her partner have access to the doctors, etc.), which may
cause some women to not disclose. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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