Prophylaxis provided to sexual assault victims seen at US emergency departments

Abstract

Objective: to report on prophylaxis provided to victims of sexual assault seen at hospital emergency departments in the United States.

Methods: Secondary analysis was performed on data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1994 to 1999. NHAMCS is a national probability sample of patient visits to US hospital emergency departments. Cases of sexual assault were identified using reason for visit, diagnostic, and injury codes. The medications provided for each case were examined.

Results: We identified 160 cases of sexual assault from 137 822 emergency department visits. None of these victims received the full regimen of antibiotics for sexually transmitted infections (STIs) recommended by the Centers for Disease Control and Prevention. Antibiotics for gonorrhea and chlamydia, 2 of the more frequently diagnosed STIs, were provided for only 24.8% of adults and adolescents. No antibiotics were ordered in 62.5% of all cases or in 51.3% of cases of patients 12 years and older. Twenty-one percent of those eligible received emergency contraception. Human immunodeficiency virus prophylaxis was amongthe medications ordered in one 1999 case. Roughly estimated, more than 60000 victims of sexual assault who visit US emergency departments annually may not be offered antibiotic treatment for the prevention of STIs.

Conclusion: Even when data limitations are taken into account, our results suggest that emergency department staff may not be routinely providing antibiotic therapy for the prevention of STIs or emergency contraception to victims of sexual assault. A comprehensive national standard of care is needed for the medical treatment of victims of sexual assault along with more training for health care providers.