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

Sexual Violence and Substance Use Diagnosed in Emergency Department Discharges in Hawaii, 2005-2014

BACKGROUND

Substance use (SU) and sexual violence (SV) present unique challenges when contextualizing their relationship due to underreporting of SU and SV. Both are significant public health concerns with a large magnitude and expense to the overall U.S. and to the state of Hawaii, which is identified as a high-intensity drug-trafficking area. Since substance users have a higher risk for sexual violence than the general public, this study aims to analyze the proportion and demographics of emergency department (ED) visit individuals reporting sexual violence with or without substance use disorder and examine how the number of ED visits of individuals diagnosed with SV and SU disorder compare to all individuals.

METHODS

Data from the Healthcare Cost and Utilization Project was used to examine the relationship between SV and SU. The database contained 3.5 million observations for 24 Hawaii hospitals from 2005-2014. The data was summarized in descriptive statistics and Chi-square tests were run to assess statistical significance for variables of interest.

RESULTS

A greater proportion of individuals reporting sexual violence also reported substance use disorders compared to the general population of individuals. While 8% of all ED visits were related to SU, 17% of ED visits involving SV were also related to SU, demonstrating a statistically significant association between SV and SU.

CONCLUSIONS

There is a greater need to further understand the complexity of the relationship between substance use and sexual violence. Sexual violence and substance use disorders share a complex relationship; survivors of sexual abuse may develop a substance use disorder, and those who use drugs and alcohol may be at an increased risk for sexual violence. Results from this study demonstrate visits for individuals reporting sexual violence have a greater proportion of substance use disorder than visits for the general population.

Emergency Department Nurses' Perceptions of Patient Substance Use, Impact on Sexual Assault Care, and Access to Follow-up Behavioral Health Resources

INTRODUCTION

Patients may present to the emergency department for sexual assault care under the influence of drugs or alcohol. However, many emergency nurses are not prepared to meet their unique needs or aware of follow-up behavioral health resources. The purpose of this study was to (1) summarize current resources provided to patients and processes for referral to behavioral health services after sexual assault care, (2) explore emergency nurses' attitudes and behaviors toward patient substance use, and (3) explore nurses' perceptions of adjunct mobile health interventions for follow-up behavioral health care and describe anticipated barriers to use.

METHODS

Fifteen emergency nurses participated in semi-structured qualitative interviews.

RESULTS

Participants had mixed perceptions of patient intoxication during sexual assault care. They felt that conversations about substance use may be more appropriate after the ED visit. Participants recognized the opportunity to connect ED patients with substance use treatment or prevention resources but perceived that there are few local service providers. Most participants were not referring patients with substance use issues to behavioral health services after sexual assault care and said that their emergency departments did not have processes for referral to these services. Acceptability of mobile health for follow-up behavioral health care was high, but participants had concerns for patient privacy and internet access. Participants gave recommendations to improve referral practices and patient engagement with mobile health interventions.

DISCUSSION

This study highlights the need for emergency nurses to consider patient intoxication during sexual assault care and opportunities to connect patients with resources post-assault.

Trends in US Emergency Department Use After Sexual Assault, 2006-2019

IMPORTANCE

Adult sexual assault (SA) survivors experience numerous emergent health problems, yet few seek emergency medical care. Quantifying the number and types of survivors presenting to US emergency departments (EDs) after SA can inform health care delivery strategies to reduce survivor morbidity and mortality.

OBJECTIVE

To quantify ED use and factors that influenced seeking ED care for adult SA from 2006 through 2019.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used SA data from the Nationwide Emergency Department Sample from 2006 through 2019, which includes more than 35.8 million observations of US ED visits from 989 hospitals, a 20% stratified sample of hospital-based EDs. The study also used the Federal Bureau of Investigation's Uniform Crime Reporting Program, which includes annual crime data from more than 18 000 law enforcement agencies representing more than 300 million US inhabitants. The study sample included any adult aged 18 to 65 years with an ED visit in the Nationwide Emergency Department Sample coded as SA. The data were analyzed between January 2020 and June 2022.

MAIN OUTCOMES AND MEASURES

Annual SA-related ED visits, subsequent hospital admissions, and associated patient-related factors (age, sex, race and ethnicity, income quartile, and insurance) were analyzed using descriptive statistics.

RESULTS

Data were from 120 to 143 million weighted ED visits reported annually from 2006 through 2019. Sexual assault-related ED visits increased more than 1533.0% from 3607 in 2006 to 55 296 in 2019. Concurrently, admission rates for these visits declined from 12.6% to 4.3%. Female, younger, and lower-income individuals were more likely to present to the ED after SA. Older and Medicaid-insured patients were more likely to be admitted. Overall, the rate of ED visits for SA outpaced law enforcement reporting.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that US adult SA ED visits increased from 2006 through 2019 and highlighted the populations who access emergency care most frequently and who more likely need inpatient care. These data can inform policies and the programming needed to support this vulnerable population.

Traumatic Injuries in Sexual Assault Patients in the Emergency Department

Introduction

The emergency department (ED) is at the forefront for treatment of sexual assault patients. Many require treatment for injuries sustained during the assault, ranging from mild to severe. Our objective in this study was to characterize types of injuries associated with sexual assault and identify associated factors.

Methods

We reviewed ED charts from an inner-city trauma center and nearby community hospital from 2019–2020 for patients age ≥13 years with a chief complaint of sexual assault. We used descriptive statistics, chi square, and logistic regression to characterize demographics and identify factors associated with trauma.

Results

A total of 157 patients met inclusion criteria. The mean age was 27.9 years old (range 13–79 years) and 92.4% were female. Adult patients (age >18 years) comprised 77.5% of assaults vs adolescents (age 13–18 years) at 22.3%. Most patients presented to the trauma center compared to the community hospital (69.4% vs 30.6%). The assailants were reported as 61.2% acquaintance, 22.9% stranger, and 15.9% intimate partner. A forensic rape kit was performed in 92 (58.6%) cases. The patient was intoxicated with alcohol in 39 (24.8%) cases, and 22 (14%) patients reported drug-facilitated assault where an unknown substance was given to them. Alcohol (P = 0.95) and drug-facilitated assault (P = 0.64) did not change the occurrence of injuries. Fifty-seven (36.3%) patients exhibited physical trauma on presentation. Forty-five (28.6%) patients had minor injuries of abrasions, lacerations, or contusions. Major trauma was defined as fracture, brain injury, hemorrhage, strangulation, or injury requiring surgical consultation. There were 12 patients with major trauma consisting of fracture injury or nonfatal strangulation. None of the patients required admission. Sexual assault by an intimate partner (odds ratio [OR] 2.6; 95% CI: 1.1–6.5) and being an adult patient compared to adolescent (OR 3.0; 95% CI, 1.1–7.7) was significantly associated with physical trauma. Sexual assault by an intimate partner was also associated with nonfatal strangulation (OR 4.0; 95% CI, 1.1–15.4).

Conclusion

Physical injuries that resulted from sexual assault were mostly minor and occurred in 36% of rape victims. Intimate partner violence was found to be associated with physical trauma as well as nonfatal strangulation. Overall, this study helps us to understand key factors associated with sexual violence.

Coding of Sexual Assault by Emergency Physicians: A Nationally Representative Study

Introduction

Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. The American College of Emergency Physicians recommends coding such visits as sexual assault rather than adding modifiers such as “alleged.”

Methods

This study reviews factors associated with coding of visits as sexual assault compared to suspected sexual assault using the 2016 Nationwide Emergency Department Sample.

Results

Younger age, female gender, a larger number of procedure codes, urban hospital location, and lack of concurrent alcohol use are associated with coding for confirmed sexual assault.

Conclusion

Implications of this coding are discussed.

Alcohol Use and Sexual Assault Among College Students: Implications for APRN Practice

The Research to Practice column is designed to provide advanced practice nurses (APRNs) with an analysis of a current research topic with implications for practice change within emergency care settings. This review examines a recent study conducted by , titled "Emergency Department Visits for Sexual Assault by Emerging Adults: Is Alcohol a Factor?" The authors conducted a retrospective chart review of emergency department (ED) visits for sexual assault among a college-age population and found most patients were female (98%) and 70% were younger than 21 years. Additionaly, among those younger than 21 years, 74% reported alcohol use at the time of their assault and 62.3% delayed presenting to the ED for care for 24 hr or more. These and other associated findings have implications for APRN practice, including reporting and documentation of these events, and risk reduction educational strategies.