Confidential Screening for Sex Trafficking Among Minors in a Pediatric Emergency Department

Abstract

Objectives: Child sex trafficking is a global health problem, with a prevalence of 4% to 11% among high-risk adolescents. The objective of this study was to confidentially administer a validated screening tool in a pediatric emergency department by using an electronic tablet to identify minors at risk for sex trafficking. Our hypothesis was that this modality of administration would adequately identify high-risk patients.

Methods: English- and Spanish-speaking patients from the ages of 12 to 17 years presenting to a large urban pediatric emergency department with high-risk chief complaints were enrolled in a prospective cohort over 13 months. Subjects completed a previously validated 6-item screening tool on an electronic tablet. The screening tool's sensitivity, specificity, and positive and negative predictive values were calculated. Multivariable logistic regression was performed to identify additional risk factors.

Results: A total of 212 subjects were enrolled (72.6% female; median age: 15 years; interquartile range 13-16), of which 26 patients were subjected to child sex trafficking (prevalence: 12.3%). The sensitivity and specificity of the electronic screening tool were 84.6% (95% confidence interval [CI] 70.8%-98.5%) and 53.2% (95% CI 46.1%-60.4%), respectively. The positive predictive value and negative predictive value were 20.2% (95% CI 12.7%-27.7%) and 96.1% (95% CI 92.4%-99.9%), respectively. A previous suicide attempt and history of child abuse increased the odds of trafficking independent of those who screened positive but did not improve sensitivity of the tool.

Conclusions: A confidentially administered, previously validated, electronic screening tool was used to accurately identify sex trafficking among minors, suggesting that this modality of screening may be useful in busy clinical environments.

FIGURE 1

Study subject enrollment emergency department (ED) flow. ^a Options of “highly likely,” “likely,” “unlikely,” “highly unlikely,” “unknown,” or “not applicable” (if screen result is negative). HT, human trafficking.

FIGURE 2

Patient screening eligibility and enrollment.

FIGURE 3

Chief complaints of enrolled patients, comparing trafficked with nontrafficked minors.

FIGURE 4

Receiver operating characteristic (ROC) curve and c-statistic of subject survey responses.