Pediatric emergency medicine trisk 4247 4247
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review process to ensure quality, synchronous (real-time) telehealth has been
evaluated in child sexual abuse, and found to improve the quality of acute
sexual assault care and the documentation of the care delivered. In addition,
patient- and caregiver attitudes and acceptance of telehealth as a tool in
providing care to the child sexual abuse patient have been deemed very
favorable as an acceptable approach to receiving high-quality, expert
forensic care. EDs and child abuse programs in the United States are
developing systems to be able to expand the sexual assault forensic expertise
to the ED with the use of telehealth solutions.
Clinical Indications for Discharge or Admission
Disposition
In most cases, the sexual assault victim may be discharged from the ED in
the care of nonoffender caregivers. On occasion, hospitalization is necessary
for treatment or observation of injuries, exacerbation of pre-existing or new
medical conditions; housing concerns, suicidal, homicidal, or other
psychiatric emergencies. If the patient is deemed medically stable for
discharge and has a safe place to go once leaving the ED, plan for follow-up
care with confirmed contact information should be obtained before final
discharge instructions and appropriate referrals provided in both oral and
written form.
Follow-Up
Victims of sexual assault must be discharged with a specific plan of care that
includes adequate follow-up with their primary care provider or child abuse
specialist, child advocacy center, and accessible psychological/mental health
services. Patients should be counseled to follow-up with their primary care
provider or child abuse specialist within 1 week to assess healing and sooner,
if symptoms occur. Victims of sexual abuse are at risk for short- and longterm psychological disturbances, such as posttraumatic stress disorder,
depression, and suicidality. Law enforcement contact information should
also be provided so that the patient can determine the status of their report.
Because infectious agents acquired through assault may not produce
sufficient concentrations of organisms to be detected during initial testing,
evaluation for STIs should be repeated within 1 to 2 weeks of the assault if
treatment was not initially provided, and/or there is the onset of STI
