Survivors of Torture: Prevalence in an Urban Emergency Department

ACADEMIC EMERGENCY MEDICINE 2012; 19:1158–1165 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: Torture has been documented in 132 countries, and approximately 400,000 survivors of torture reside in the United States. It is unknown if torture survivors seek medical care in emergency departments (EDs). The authors set out to estimate the prevalence of survivors of torture presenting to an urban ED. Methods: A cross-sectional survey of ED patients was performed by convenience sampling from October 2008 to September 2009 in a large urban teaching hospital in New York City. ED patients not of a vulnerable population were consented and entered into the study. Participants were asked two screening questions to ascertain if they were self-reported survivors of torture. For exploratory purposes only, these individuals were further queried about their experiences. The detailed responses of these self-reported survivors of torture were compared to the United Nations Convention Against Torture (UNCAT) definition by a blinded, independent panel. Results: Of 470 study participants, 54 individuals (11.5%, 95% confidence interval [CI] = 8.6% to 14.4%) self-reported torture. Nine (16.7%) had ongoing physical disabilities, 30 (55.6%) had recurrent intrusive and distressing memories, 42 (77.8%) never had a physician inquire about torture, and only eight (14.8%) had requested political asylum. Of these self-reported survivors of torture, 29 (53.7%) met the UNCAT definition, for an adjudicated prevalence of 6.2% (95% CI = 4.3% to 8.7%). Conclusions: Self-reported survivors of torture presented to this urban ED, and a significant proportion of them met the UNCAT definition of a torture survivor. Continuing torture-related medical and psychological sequelae were identified, yet there was a low rate of asylum-seeking. Only a minority were previously identified by a physician. These data suggest an unrecognized public health concern and an opportunity for emergency physicians to intervene and refer survivors of torture to existing community resources. Resumen Objetivos: La tortura ha sido documentado en 132 paises, y aproximadamente 400.000 supervivientes de tortura residen en los Estados Unidos. Se desconoce si los supervivientes de tortura buscan atencion medica en los servicios de urgencias (SU). Se quiso estimar la prevalencia de supervivientes de tortura entre los pacientes que acuden a un SU urbano. Metodo: Se realizo una encuesta transversal a los pacientes del SU mediante un muestro de conveniencia desde octubre del 2008 a septiembre del 2009 en un hospital universitario urbano en la ciudad de Nueva York. Se incluyo en el estudio a los pacientes no vulnerables del SU que dieron su consentimiento. Se pregunto a los participantes dos preguntas de despistaje para determinar si autorreferian ser supervivientes de tortura. Con el unico proposito de investigar, a estos individuos se les pregunto mas sobre sus experiencias. Las respuestas detalladas de estos autorreferidos supervivientes de tortura se compararon con la definicion de la United Nations Convention Against Torture (UNCAT) por un grupo de profesionales independiente enmascarado. Resultados: De los 470 participantes del estudio, 54 sujetos (11,5%, IC 95% = 8,6% a 14,4%) autorreferian haber sido torturados. Nueve (16,7%) habian desarrollado discapacidad fisica, 30 (55,6%) tenian recuerdos recurrentes intrusivos y angustiosos, 42 (77,8%) nunca fueron preguntados sobre la tortura por un medico y solo 8 (14,8%) tenian solicitado asilo politico. De estos autorreferidos supervivientes de tortura, 29 (53,7%) cumplian la definicion de la UNCAT, lo que significa una prevalencia de 6,2% (IC 95% = 4,3% a 8,7%). Conclusiones: De los autorreferidos supervivientes de tortura que acudieron al SU urbano, un porcentaje significativo de ellos cumplieron la definicion de la UNCAT de superviviente de tortura. A pesar que se continuan identificando secuelas psicologicas y medicas a consecuencia de la tortura, todavia hay un bajo porcentaje de solicitud del asilo. Solo una minoria habia sido previamente identificada por un medico. Estos datos sugieren un problema de salud no reconocido y una oportunidad para los urgenciologos para intervenir y derivar a los supervivientes de tortura a los recursos comunitarios disponibles.