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American Academy of Pediatrics
Article

Testing and Treatment After Adolescent Sexual Assault in Pediatric Emergency Departments

Samantha Schilling, Margaret Samuels-Kalow, Jeffrey S. Gerber, Philip V. Scribano, Benjamin French and Joanne N. Wood
Pediatrics December 2015, 136 (6) e1495-e1503; DOI: https://doi.org/10.1542/peds.2015-2093
Samantha Schilling
Divisions of aGeneral Pediatrics and
bLeonard Davis Institute of Health Economics,
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Margaret Samuels-Kalow
bLeonard Davis Institute of Health Economics,
cEmergency Medicine, and
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Jeffrey S. Gerber
Departments of dPediatrics, and
eBiostatistics and Epidemiology, and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Philip V. Scribano
Divisions of aGeneral Pediatrics and
Departments of dPediatrics, and
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Benjamin French
bLeonard Davis Institute of Health Economics,
eBiostatistics and Epidemiology, and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Joanne N. Wood
Divisions of aGeneral Pediatrics and
bLeonard Davis Institute of Health Economics,
Departments of dPediatrics, and
fPolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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Abstract

OBJECTIVE: To examine rates of recommended of testing and prophylaxis for chlamydia, gonorrhea, and pregnancy in adolescents diagnosed with sexual assault across pediatric emergency departments (EDs) and to determine whether specialized sexual assault pathways and teams are associated with performance of recommended testing and prophylaxis.

METHODS: In this retrospective study of 12- to 18-year-old adolescents diagnosed with sexual assault at 38 EDs in the Pediatric Hospital Information System database from 2004 to 2013, information regarding routine practice for sexual assault evaluations and presence and year of initiation of specialized ED sexual assault pathways and teams was collected via survey. We examined across-hospital variation and identified patient- and hospital-level factors associated with testing and prophylaxis using logistic regression models, accounting for clustering by hospital.

RESULTS: Among 12 687 included cases, 93% were female, 79% were <16 years old, 34% were non-Hispanic white, 38% were non-Hispanic black, 21% were Hispanic, and 52% had public insurance. Overall, 44% of adolescents received recommended testing (chlamydia, gonorrhea, pregnancy) and 35% received recommended prophylaxis (chlamydia, gonorrhea, emergency contraception). Across EDs, unadjusted rates of testing ranged from 6% to 89%, and prophylaxis ranged from 0% to 57%. Presence of a specialized sexual assault pathway was associated with increased rates of prophylaxis even after adjusting for case-mix and temporal trends (odds ratio 1.46, 95% confidence interval 1.15 to 1.86).

CONCLUSIONS: Evaluation and treatment of adolescent sexual assault victims varied widely across pediatric EDs. Adolescents cared for in EDs with specialized sexual assault pathways were more likely to receive recommended prophylaxis.

  • Accepted September 8, 2015.
  • Copyright © 2015 by the American Academy of Pediatrics

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Pediatrics
Vol. 136, Issue 6
1 Dec 2015
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Testing and Treatment After Adolescent Sexual Assault in Pediatric Emergency Departments
Samantha Schilling, Margaret Samuels-Kalow, Jeffrey S. Gerber, Philip V. Scribano, Benjamin French, Joanne N. Wood
Pediatrics Dec 2015, 136 (6) e1495-e1503; DOI: 10.1542/peds.2015-2093

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Testing and Treatment After Adolescent Sexual Assault in Pediatric Emergency Departments
Samantha Schilling, Margaret Samuels-Kalow, Jeffrey S. Gerber, Philip V. Scribano, Benjamin French, Joanne N. Wood
Pediatrics Dec 2015, 136 (6) e1495-e1503; DOI: 10.1542/peds.2015-2093
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