Emergency Department Characteristics of Male Sexual Assault

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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Achieving just outcomes: forensic evidence collection in emergency department sexual assault cases

Emergency Medicine Journal ◽

10.1136/emermed-2018-207485 ◽

2018 ◽

pp. emermed-2018-207485

Author(s):

Katherine A Muldoon ◽

Allegra Drumm ◽

Tara Leach ◽

Melissa Heimerl ◽

Kari Sampsel

Keyword(s):

Emergency Department ◽

Sexual Assault ◽

Forensic Evidence ◽

Evidence Collection

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Emergency Department Visits for Sexual Assault by Emerging Adults: Is Alcohol a Factor?

Western Journal of Emergency Medicine ◽

10.5811/westjem.2018.6.38219 ◽

1996 ◽

Vol 19 (5) ◽

pp. 797-802 ◽

Cited By ~ 2

Author(s):

Allison Tadros ◽

Melinda Sharon ◽

Shelley Hoffman ◽

Danielle Davidov

Keyword(s):

Emergency Department ◽

Sexual Assault ◽

Emerging Adults ◽

Emergency Department Visits

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Improving emergency department care of the sexual assault victim

Annals of Emergency Medicine ◽

10.1016/s0196-0644(80)80061-8 ◽

1980 ◽

Vol 9 (6) ◽

pp. 293-297 ◽

Cited By ~ 11

Author(s):

Shirley Talbert ◽

Susan D. White ◽

John D. Bowen ◽

Linda M. Stephens ◽

Sara J. Mapstone ◽

...

Keyword(s):

Emergency Department ◽

Sexual Assault ◽

Emergency Department Care

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Development and evaluation of sexual assault training for emergency department staff in Ontario, Canada

Nurse Education Today ◽

10.1016/j.nedt.2018.08.025 ◽

2018 ◽

Vol 70 ◽

pp. 124-129 ◽

Cited By ~ 2

Author(s):

Janice Du Mont ◽

Shirley Solomon ◽

Sarah Daisy Kosa ◽

Sheila Macdonald

Keyword(s):

Emergency Department ◽

Sexual Assault ◽

Emergency Department Staff ◽

Department Staff

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MP07: Rate of return: prevalence and correlates of revictimization among sexual and domestic assault cases presenting to the emergency department

CJEM ◽

10.1017/cem.2018.161 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S42-S42

Author(s):

A. Drumm ◽

K. Muldoon ◽

F. Blaskovits ◽

T. Leach ◽

M. Heimerl ◽

...

Keyword(s):

Emergency Department ◽

Domestic Violence ◽

Substance Use ◽

Sexual Assault ◽

Care Program ◽

Sexual Assaults ◽

Domestic Assault ◽

Ottawa Hospital ◽

High Prevalence ◽

Patients At Risk

Introduction: Many survivors of sexual and domestic assault return to violent environments following post-assault care. The objective of this study was to estimate the annual prevalence of revictimization and examine factors associated with return emergency department (ED) visits following their initial encounter for sexual or domestic assault. Methods: The Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital is the only program in Ottawa offering emergency and forensic care for survivors of sexual assault and domestic violence. Information on demographics, assailant characteristics and clinical presentation were extracted from the SAPACP case registry (January 1 2015- January 31 2016). We conducted descriptive analyses to describe the study sample, and bivariable and multivariable logistic regression modelling to assess factors most strongly associated with revictimization using odds ratios (OR), adjusted OR (AOR) and 95% confidence intervals (CI). Results: Among 377 unique patients seen at the SAPACP, there were 409 encounters for sexual and domestic violence. There were 24 revictimization cases (6.4%) with the number of repeat visits ranging from 2-6. There were 343 (91.0%) female patients and 182 (48.3) under the age of 25. There were 243 (64.5%) sexual assaults, 125 (33.2%) physical assaults, and 42 (11.1%) verbal assaults. Compared to patients who presented once, revictimized patients were more likely to have experienced violence from a current or former intimate partner (AOR:3.02, 95% CI:1.24-7.34), have a substance use disorder (AOR:5.57, 95% CI:2.11-14.68), and were more likely to be taking anti-depressants (AOR:3.34, 95% CI:1.39-8.01). Conclusion: This study has identified a high prevalence of revictimization, with some clients being revictimized as many as 6 subsequent times. Key factors to help identify patients at risk of revictimization are assaults by intimate partners, having substance use problems, and being on antidepressants. Reducing revictimization and preventing further violence is a critical component of care to ensure survivors are safe following their ED encounter.

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