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Adolescent sexual assault victims not receiving STI testing or prophylaxis

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Care of adolescent sexual assault suboptimal

These data highlight the widespread variation and perhaps suboptimal care adolescent victims of sexual assault receive [and] the fact that specialized sexual assault teams, and guidelines, in isolation, may not influence care to a great extent.

Although patient-level factors may account in part for low rates of testing and prophylaxis, the significant discrepancies between reported and actual rates of testing and prophylaxis suggest that hospital-level factors should be examined to identify opportunities to improve care for this patient population.

Dr Mark I. Neuman is with the division of emergency medicine at Boston Children’s Hospital. Dr. Nancy D. Kellogg is with the division of child abuse/department of pediatrics at the University of Texas Health Science Center at San Antonio. These comments are excerpted from an accompanying editorial (Pediatrics 2015 Nov 2. doi: 10.1542/peds.2015-3346). The authors had no relevant financial disclosures.


 

FROM PEDIATRICS

References

Fewer than half of adolescents who present at emergency departments after a sexual assault are tested for infections or receive recommended prophylaxis against sexually transmitted infections and pregnancy, investigators reported.

A retrospective study of 12,687 12- to 18-year-old adolescents (93% female) treated for sexual assault at 38 emergency departments showed that, overall, 44% received the recommended testing for chlamydia, gonorrhea, and pregnancy (range, 6%-89%), while 35% received recommended prophylaxis (range, 0-57%).

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About one-third of patients presented to a hospital with a clinical pathway – which was associated with a 46% greater likelihood of receiving prophylaxis but no increase in testing rates – and two-thirds presented to hospitals with a specialized sexual assault evaluation team, which did not significantly impact testing or prophylaxis rates.

“In spite of laws in all 50 states that limit the evidentiary use of a victim’s previous sexual history to protect the credibility of the victim’s testimony, 26% of the EDs endorsed not performing STI testing during the acute evaluation at least some of the time due to this concern,” wrote Dr. Samantha Schilling, who conducted the research while at the Children’s Hospital of Philadelphia and is now with the University of North Carolina, Chapel Hill, and her coauthors (Pediatrics 2015 Nov 2. doi: 10.1542/peds.2015-2093).

One author was funded by the National Institute of Child Health and Human Development; the other authors had no relevant financial disclosures.

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