Sexually assaulted adolescents often receive suboptimal emergency care

A new study reveals vast disparities in the treatment of adolescent sexual assault victims by emergency departments across the country, with many victims leaving the ER without recommended tests and preventive treatments. The findings of the study, led by UNC Children’s Dr. Samantha Schilling, were published in the Nov. 2 edition of the journal Pediatrics.

Sexually assaulted adolescents often receive suboptimal emergency care click to enlarge Dr. Samantha Schilling

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Tuesday, Nov. 3, 2015

Approximately one in four girls and one in seven boys will experience sexual assault or abuse before reaching age 18. Despite the prevalence of sexual violence against children, new research reveals many adolescent victims who seek treatment at an emergency department following an assault receive suboptimal care. The study, led by UNC Children’s pediatrician, Samantha Schilling, MD, MSHP, was published in the Nov. 2 edition of the journal Pediatrics.

“Adolescents come to emergency departments all around the country every day, yet depending on which emergency department, the medical care a child receives following sexual assault is different,” says Dr. Schilling, an assistant professor of pediatrics at the UNC School of Medicine, of the study’s findings. “In the majority of cases, the victim leaves the ED without receiving all the appropriate diagnostic testing and prophylaxis for sexually transmitted infections and pregnancy.”

Using the Pediatric Hospital Information System, a large administrative database containing hospital and patient information, Schilling and her research colleagues at the Children’s Hospital of Philadelphia studied pediatric emergency department care practices of adolescents who have been sexually assaulted. They examined the records of 12,687 adolescents, aged 12 to 18, who were evaluated for sexual assault at 38 pediatric emergency departments over a 10-year period. What they found brings to light knowledge gaps regarding published testing and treatment guidelines and the need for greater awareness.

“Altogether, rates of children receiving appropriate medical care were poor,” explains Dr. Schilling. “We found that 44 percent of children received the recommended testing and 35 percent the recommended preventive treatments.” 

Previous studies have shown evidence-based guidelines can decrease care variability and improve clinical outcomes. Schilling says her study supports these conclusions and cites hospitals adopting a specialized clinical pathway—or a specific, step-based care plan for evaluating children with acute sexual assault—as an important first step. She also recommends that hospitals allocate resources and train physicians and nurses to become competent and knowledgeable in conducting medical evaluations for sexual assault.

“Families experiencing the victimization of their son or daughter are in crisis,” comments Schilling. “When they present to an emergency department for medical care, ensuring appropriate tests and preventative treatment for the child reassures the family that future impact to the child’s health has been minimized, reducing stress in an already challenging situation. We can do a better job supporting these families.”


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