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

Abstract

ImportanceAdult 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.ObjectiveTo quantify ED use and factors that influenced seeking ED care for adult SA from 2006 through 2019.Design, Setting, and ParticipantsThis 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 MeasuresAnnual 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.ResultsData 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 RelevanceThis 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.

Sexual Violence—Another Public Health Emergency

“…In addition to strengthening the acute response to SA, greater effort is needed globally to prevent sexual violence. The increased awareness and reporting of SA noted by Vogt et al 4 is certainly one step in a multilevel response needed for addressing sexual violence. 13 Comprehensive…”

“…2 Two articles in JAMA Network Open report on the incidence of CSA and adult SA cases reported to emergency departments (EDs) in Hong Kong and the US, respectively. 3,4 Wong et al 3 report on incident rates of CSA among youth presenting to EDs in Hong Kong before and during the COVID-19 pandemic. By using medical record data from EDs across Hong Kong, they found that the number of ED visits to report CSA decreased more than 50% during the pandemic.…”

“…As is true for sexual violence prevalence estimates that rely on official reporting, the observed prevalence is likely to be a significant underestimate of actual cases of sexual violence, given the vast number of incidents that are not reported. 1 Vogt et al 4 studied trends in US ED use after adult SA from 2006 to 2019, before the COVID-19 pandemic, finding a 15-fold increase in ED use during that period. The authors speculated that overall increases in survivor help seeking at EDs may be related to 2 factors: increased recognition and reporting of SA among ED staff and International Classification of Diseases, Tenth Revision coding changes that allow for more specific documentation of SA.…”

“…2 Two articles in JAMA Network Open report on the incidence of CSA and adult SA cases reported to emergency departments (EDs) in Hong Kong and the US, respectively. 3,4 Wong et al 3 report on incident rates of CSA among youth presenting to EDs in Hong Kong before and during the COVID-19 pandemic. By using medical record data from EDs across Hong Kong, they found that the number of ED visits to report CSA decreased more than 50% during the pandemic.However, the study's core finding was that the proportion of CSA cases among adolescent girls increased during 2020 to 2021 compared with previous years, using either the overall population or ED visits as the denominator.…”

“…6 In addition to implementing more robust responses to sexual violence in the ED, other health and social service settings should be encouraged to collaborate formally to strengthen the response to sexual violence. For example, as suggested by Vogt et al, 4 trained SA nurse examiners enhance the quality of examinations in ED settings using patient-centered, trauma-informed care models. However, the specialty faces a persistent shortage of professionals, limiting access to quality post-SA care.…”