DV / IPV Assessment: HITS Screen and Danger Review

What it does

This point-of-care tool combines two parts. Part A is the HITS screen (Hurt, Insult, Threaten, Scream), completed with the patient. Part B is a structured lethality and danger review, completed from the interview and the record. The tool asks you to interview the patient alone, frame the questions as routine for everyone, and never use the partner or family as an interpreter. Asking in front of the partner can increase danger.

Part A: HITS screen

Four items ask how often, over the last 12 months, the partner physically hurt, insulted or talked down to, threatened harm to, or screamed or cursed at the patient. Each is rated 1 (never) to 5 (frequently), for a total of 4 to 20.

HITS total	Result
4-10	Below screening threshold
11-20	Positive screen

A negative screen does not rule out abuse. Clinical suspicion overrides it.

Part B: danger review

Four high-risk markers are flagged separately: partner access to a firearm, prior strangulation, threats to kill the patient, children or self, and the patient's belief that the partner could kill them. Any "yes" brings up an alert to prioritize urgent, private safety planning with a domestic violence advocate. Nine further risk factors are also recorded, including escalating violence, recent separation, stalking or controlling behavior, forced sex, violence in pregnancy, threats toward children, partner substance use, partner suicidality, and prior weapon use. Part B is a structured clinical review, not a validated score, and has no cutoff.

What the report includes

The report lists the date, relationship context, HITS total and item responses, each danger-review item, a summary, any clinician note, and hotline resources (National DV Hotline 1-800-799-7233). Sources cited in the tool are Sherin KM et al. (Fam Med, 1998) for HITS, and Campbell JC et al. (Am J Public Health, 2003) and Glass N et al. (J Emerg Med, 2008) for the danger review. Check what is safe to document and release, and know your jurisdiction's mandatory-reporting duties.