Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1660-e1667 (doi:10.1542/peds.2007-3100)
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ARTICLE

Compliance in Rhode Island Emergency Departments With American Academy of Pediatrics Recommendations for Adolescent Sexual Assaults

Roland C. Merchant, MD, MPHa,b, Erin T. Kelly, ABc, Kenneth H. Mayer, MDb,d, Bruce M. Becker, MD, MPHa,b, Susan J. Duffy, MD, MPHa,e and David L. Pugatch, MDf

a Departments of Emergency Medicine
b Community Health
e Pediatrics
d Departments of Medicine
f Pediatrics
c Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island

OBJECTIVES. We assessed the offering of American Academy of Pediatrics–recommended tests and prophylaxes after sexual assault to adolescents who presented to Rhode Island emergency departments for 3 categories of sexual exposures: sexual assault, consensual sex, and suspected sexual abuse.

PATIENTS AND METHODS. This study entailed a retrospective review of visits for adolescent sexual exposures across 11 Rhode Island emergency departments between January 1995 and June 2001. Cases were identified through billing codes. Offering of each test and prophylaxis was compared by gender, category of sexual exposure, and type of sexual assault. Multivariable linear regression models were used to identify factors associated with the offering of a greater number of tests and prophylaxes after sexual assault.

RESULTS. The vast majority of emergency department visits for adolescent sexual exposures were by sexually assaulted girls (82.5%). Across the 3 sexual exposure categories, girls were offered tests and prophylaxes more often than boys (eg, chlamydia or gonorrhea testing and prophylaxis). Among sexually assaulted adolescents, 32.8% of girls and no boys were offered all recommended tests and prophylaxes. The multivariable linear regression found that vaginally and/or anally assaulted girls were offered, on average, 2.5 more tests and prophylaxes than patients with other types of sexual assaults. Girls presenting for care at the state's women's health care specialty hospital emergency departments were offered 1.7 more tests and prophylaxes than those evaluated in general hospital emergency departments.

CONCLUSIONS. Many adolescents did not receive American Academy of Pediatrics–recommended tests and prophylaxes after sexual assault. Boys received fewer tests than girls. Testing and prophylaxis varied by type of emergency department. Efforts are needed to improve and standardize emergency department medical management of adolescent sexual exposures.

Key Words: adolescent • sexual child abuse • guideline adherence • rape • sexual abuse

Abbreviations: ED—emergency department • AAP—American Academy of Pediatrics • EC—emergency contraception • PEP—postexposure prophylaxis • ICD-9—International Classification of Diseases, Ninth Revision, Clinical Modification • RR—risk ratio • CI—confidence interval

Accepted Nov 28, 2007.


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