Pediatric emergency medicine trisk 4228 4228
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Patients are triaged based on injury/symptom severity and the potential need
for ED resources. Patients presenting after sexual assault with any of the
following are triaged as ESI level 2: acute assault within 72 hours in
postpubertal patients or within 24 to 72 hours in prepubertal patients;
evidence/concern for trauma; or complaint of abdominal pain or genital
symptoms. Patients are instructed to remain clothed, refrain from eating or
drinking, and avoid urination if possible until decision is made regarding
forensic evidence collection.
Initial Assessment
A team approach limits the number of times a history is given, and the
number of times a patient is examined. Treat unstable patients or patients
with significant injuries promptly treated as any other trauma patients.
Attempt to preserve clothing and other potential evidence, if possible. For
stable patients, the evaluation begins with history taking, ideally with all
relevant team members (physician, nurse, sexual assault examiner, social
worker) present.
A minimal facts interview, assessing the types of sexual contact guides
forensic evaluation and treatment decisions and assists with interpretation of
physical examination. Victims will likely be interviewed in detail by law
enforcement, forensic interviewers, and CPS personnel, and so it is
unnecessary to obtain great detail about the event in the ED setting. Key
elements to a minimal facts interview include: timing and location of assault;
type of sexual contact (oral-genital, genital-genital, anogenital, etc.),
perpetrator characteristics (age, relationship, any known history of STIs),
and any use of drugs/alcohol or threats of weapons to facilitate the assault.
Avoiding repetitive, detailed interviews minimizes the potential for
inconsistent stories. In younger patients, much or all of the history of the
assault can be obtained from family members, police, and CPS workers.
Adolescent patients can provide the relevant details themselves, and should
be interviewed alone, unless the patient objects to the parent leaving the
room. However, it is ideal to interview children of all ages alone when
possible, in order to minimize the influence of parental presence. Important
tips for interviewing include the use of open-ended question, that is, “Tell
me what happened,” using developmentally appropriate language and the
child’s own words to describe their body parts. When making a
