Testing and Prophylaxis for Adolescent Victims of Sexual Assault in Pediatric EDs

Katherine Bakes, MD reviewing Neuman MI and Kellogg ND. Pediatrics 2015 Nov 2.

Compliance with recommended testing and prophylaxis for adolescent victims of sexual assault was unacceptably low and highly variable among 38 pediatric emergency departments.

For adolescent victims of sexual assault, the American Academy of Pediatrics and the CDC recommend testing for chlamydia and gonorrhea; prophylaxis for chlamydia, gonorrhea, and trichomonas; pregnancy testing; and emergency contraception for female victims presenting within 120 hours of assault. In a retrospective study, investigators reviewed testing and prophylaxis practices for 12,687 adolescent victims (age, 12–18 years) of sexual assault (93% female) who presented to 38 pediatric emergency departments (EDs) from 2004 to 2103.

Overall, 30% of patients presented to EDs with standardized sexual assault clinical pathways and 64% to EDs with specialized evaluation teams. Only 44% of patients received recommended testing. Testing rates across hospitals ranged from 6% to 89% for all recommended tests, 14% to 92% for chlamydia, 8% to 92% for gonorrhea, and 15% to 95% for pregnancy. Despite laws in all states prohibiting the evidentiary use of a victim's previous sexual history, 26% of EDs withheld testing due to concern for discrediting the victim.

Testing rates were not associated with presence of a standardized pathway or specialized team. Only 35% of patients received all recommended prophylaxis (range across hospitals, 0%–57%). Hospitals with standardized pathways were more likely to provide prophylaxis than hospitals without pathways (odds ratio, 1.5); however, presence of specialized teams was not associated with prophylaxis rates.

Citation(s):

Neuman MI and Kellogg ND.Testing and treating sexually assaulted adolescents: What are we waiting for? Pediatrics 2015 Nov 2; [e-pub].