Pediatric emergency medicine trisk 4221 4221
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CHAPTER 127 ■ SEXUAL ASSAULT: CHILD
AND ADOLESCENT
JENNIFER MOLNAR, MEGAN SCHLUCKEBIER O’CONNELL, CYNTHIA MOLLEN, PHILIP
SCRIBANO
GOALS OF EMERGENCY CARE
Treat life-threatening or limb-threatening injuries first, although the vast
majority of sexually assaulted patients will not require such immediate
intervention.
Determine best location and care team for the patient. All patients
presenting to the emergency department (ED) must have a medical
screening examination and psychosocial evaluation to determine whether
an emergency condition exists that requires further treatment. If there is no
urgency for evaluation of possible injury, forensic evidence collection, or
acute or prophylaxis treatment, a complete and thorough examination can
be scheduled for a later date with a child abuse subspecialist.
An emergency examination is indicated if the alleged assault occurred
within the preceding 72 hours in postpubertal patients and within the
preceding 24 to 72 hours in prepubertal patients, or if the patient has
genital complaints or other symptoms requiring medical attention, or if the
safety of the child is in question.
A coordinated, multidisciplinary team approach to the evaluation provides
victims with access to comprehensive care, minimizes potential trauma,
encourages the use of community resources, and may help facilitate legal
investigation.
Comprehensive care includes history and physical examination,
psychosocial screening, photo documentation of injury, forensic evidence
collection, STI screening and prophylaxis (including HIV), pregnancy
prophylaxis, crisis management, reporting to child protection services
(CPS) and law enforcement, and ensuring medical as well as psychosocial
follow-up care.
A successful sexual assault response team (SART) program requires
ongoing team education, debriefing sessions, case review for quality
