Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113458

Roland Merchant, MD, MPH, Emergency Medicine and Community Health, Brown Medical School, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, (401) 444-5109, rmerchant@lifespan.org, Kenneth H. Mayer, MD, Fenway Community Health Research Department, Brown University School of Medicine, 7 Haviland Street, Boston, MA 02115, Bruce M. Becker, MD, MPH, Department of Community Health, Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, David Pugatch, MD, Department of Pediatrics, Brown Medical School, 593 Eddy Street, Providence, RI 02903, and Susan Duffy, MD, Emergency Medicine and Pediatrics, Brown Medical School, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903.

Objectives: Compare the frequencies pediatric sexual assault (SA) patients are offered and accept STD and pregnancy testing and prophylaxis

Methods: Statewide retrospective review of all 1995-mid 2001 ED visits for SA by patients < age 18. Visits were identified by ICD-9 codes. Frequency distributions for tests and prophylaxis, odds ratios (ORs) comparing the frequency of each, and corresponding 95% CIs were calculated.

Results: Of 664 patients with SA, the median age was 13; 87% were female; 53% had anal or vaginal SA; and 81% presented <3 days after the SA. Among patients anally or vaginally assaulted, 77.0% (72.2-81.3) were offered gonorrhea/chlamydia (GC) testing, 57.1% (51.7-62.3) syphilis testing, 57.7% (52.3-62.9) STD prophylaxis, and 7.6% (6.9-9.6) HIV prophylaxis. Among similar non-pregnant 12-17-year-old females, 83.2% (78.2-87.4) were offered pregnancy testing and 50.4% (44.3-56.4) were offered emergency contraception (EC). Almost all patients offered STD and pregnancy testing and prophylaxis accepted but only 49.2% accepted HIV prophylaxis. Among patients anally or vaginally assaulted, ORs comparing offering GC testing to other testing and prophylaxis were 2.51 [1.79-3.53] for syphilis testing, 2.46 [1.75-3.45] for STD prophylaxis, and 18.46 [12.39-27.57] for HIV prophylaxis. Similar non-pregnant 12-17-year-old females were 5.77 [3.76-8.92] more likely to be tested for pregnancy than offered EC but equally likely to be tested for GC 1.21 [0.75-1.97].

Conclusions: A slim majority of pediatric ED patients potentially eligible to receive STD prophylaxis and less than half eligible for EC were offered it. Syphilis testing, STD prophylaxis, EC, and perhaps HIV prophylaxis appear to be under utilized.

Learning Objectives:

• Learn how often STD and pregnancy testing and prophylaxis was offered and accepted by pediatric sexual assault survivors.
• Understand the comparative frequencies STD and pregnancy testing and prophylaxis was utilized for these patients.
• Consider the potential barriers to STD and pregnancy testing and prophylaxis in the ED for pediatric sexual assault survivors.

Keywords: Sexual Assault, Emergency Department/Room

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation