Impact of sexual assault nurse examiners on the evaluation of sexual assault in a pediatric emergency department.
ABSTRACT Nearly 44% of sexual assault victims in the United States are younger than 18 years. These victims often present to emergency departments for care after the assault. To date, the effectiveness of sexual assault nurse examiners (SANEs) on the evaluation and management of pediatric and adolescent sexual assault victims in a pediatric emergency department (PED) has not been evaluated.
To evaluate whether the use of SANEs in a PED improves the medical care of pediatric and adolescent sexual assault victims.
Medical records of patients who presented to an urban PED with a history of sexual assault and required forensic evaluation (rape kit) from December 2004 to December 2006 were reviewed in a retrospective, blinded fashion for the following documentation: (1) the genitourinary (GU) examination and if a GU injury was present; (2) evaluation for sexually transmitted infections (STIs) (Neisseria gonorrhoeae and Chlamydia trachomatis), and serologies for hepatitis B and C, HIV, and VDRL; (3) prescription of prophylaxis for STIs, HIV, and pregnancy; (4) evaluation by a PED social worker; and (5) referral to sexual assault crisis services. Patients were grouped as to whether a SANE had been involved in their care. The assignment of a patient to a SANE was random, as SANEs in the PED of this institution do not take call from home and are present in the PED as part of their routine nursing shift. To examine the differences between groups, chi analysis or Fisher exact test was used.
Of the 114 patients whose medical records were reviewed, 60 had been evaluated by a SANE (SANE), and 54 patients had not (SANE); 98% of patients were girls. There were no differences between the 2 patient groups with respect to time of day when they presented to the PED, time after assault to presentation to the PED, sex, age, or race. All medical records had the history of the sexual assault documented in the medical record. Patients evaluated by a SANE were more likely to have the GU examination documented (71% vs 41%; P < 0.001) and to have GU injury documented (21% vs 0%; P = 0.024). Eligible patients were more likely to have testing for N. gonorrhoeae and C. trachomatis (98% vs 76%; P < or = 0. 001), and serologies for hepatitis B and C (95% vs 80%%; P = 0.03) and HIV (93% vs 72%; P = 0.03) when a SANE had been involved in their care. There were no significant differences between groups with respect to obtaining serology for VDRL. There were no significant differences between groups with respect to provision of prophylaxis for N. gonorrhoeae, C. trachomatis, or HIV. Significantly more patients were prescribed prophylaxis for pregnancy by a SANE (85% vs 64%; P = 0.025). Although there were no significant differences between groups with respect to an evaluation by a PED social worker, significantly more patients in the SANE group were referred to the Rape Crisis Center for support and counseling (98% vs 30%; P < 0.001).
Many more patients who had been sexually assaulted received STI testing, pregnancy prophylaxis, and referrals to the Rape Crisis Center when a SANE was present for the evaluation in the PED. Even with a SANE providing medical care, not all eligible patients had medical record documentation of the GU examination or that they received appropriate STI testing or STI and HIV prophylaxis. Ongoing quality assurance in programs that use SANEs is needed to ensure optimal medical evaluation of children and adolescents with sexual assault.
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ABSTRACT: There is an escalating epidemic of rape in the United States. All victims have psychological injury, and over half sustain physical injury in the assault. The response of health care professionals to these women demands sensitivity and expertise. A focused history and well-documented physical examination are crucial. Consistency among the history and physical findings, objective findings of recent trauma, and evidence of recent sexual activity are critical. Compliance with forensic protocols ensures that this information will be available for criminal proceedings. Long-term follow-up care and psychological support are necessary for the woman to make the transition from victim to survivor.New England Journal of Medicine 02/1995; 332(4):234-7. · 51.66 Impact Factor
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ABSTRACT: We sought to provide a descriptive study of the Sexual Assault Nurse Examiner (SANE) programs and their characteristics in the United States. A confidential survey addressing patient and staff demographics, administration attributes, examination procedures, and medical and legal issues was mailed to SANE programs in the United States. Sixty-one (66%) of 92 programs responded. More than half of the programs (32/58 [55%]) had been in operation for less than 5 years. Thirty (52%) of the 58 programs performed the initial sexual assault examination in hospital emergency departments. Written consent (57/59 [97%]) was obtained for the initial examination, and most (51/59 [86%]) programs used preprepared commercial sexual assault kits. Program directors were predominately registered nurses. All but one program mandated specific training requirements for their staff, with a median requirement of 80 hours. Procedures used for initial examinations varied; most offered pregnancy testing (56/58 [97%]), pregnancy prophylaxis (57/59 [97%]), and sexually transmitted disease (STD) prophylaxis (53/59 [90%]). HIV testing was not offered in 32 (54%) of 59 programs. Almost all programs used Wood's lamp (51/59 [86%]), colposcopes (42/59 [71%]), and photographs (46/59 [78%]) for documentation. Median time required per patient for initial examination and evidence collection was 3 hours (range, 1 to 8 hours). Follow-up is consistently offered to the survivor. Most programs (45/61 [74%]) could report the number of survivors treated, but few could provide information on survivor medical follow-up or the number of prosecutions by survivors and their outcomes. This survey provided an overview of SANE programs. SANE programs are similar across the country with regard to staffing, training, STD and pregnancy prophylaxis, and documentation techniques. They are inconsistent in the use of STD cultures, HIV testing, and alcohol and drug screening. SANE programs were unable to provide data regarding survivor follow-up and legal outcomes. This information is essential to evaluate the programs' effectiveness and to improve performance. The need for better outcome data should be addressed to define success or failure of SANE programs.Annals of Emergency Medicine 05/2000; 35(4):353-7. · 4.29 Impact Factor
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ABSTRACT: Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations, including rape. Since the American Academy of Pediatrics published its last policy statement on this topic in 1994, additional information and data have emerged about sexual assault and rape in adolescents, the adolescent's perception of sexual assault, and the treatment and management of the adolescent who has been a victim of sexual assault. This new information mandates an updated knowledge base for pediatricians who care for adolescent patients. This statement provides that update, focusing on sexual assault and rape in the adolescent population.PEDIATRICS 07/2001; 107(6):1476-9. · 4.47 Impact Factor