title: Testing and Treatment After Adolescent Sexual Assault in Pediatric Emergency Departments.
abstract: OBJECTIVE
  To examine rates of recommended of testing and prophylaxis for chlamydia, gonorrhea, and pregnancy in adolescents diagnosed with sexual assault across pediatric emergency departments (EDs) and to determine whether specialized sexual assault pathways and teams are associated with performance of recommended testing and prophylaxis.
  
  
  METHODS
  In this retrospective study of 12- to 18-year-old adolescents diagnosed with sexual assault at 38 EDs in the Pediatric Hospital Information System database from 2004 to 2013, information regarding routine practice for sexual assault evaluations and presence and year of initiation of specialized ED sexual assault pathways and teams was collected via survey. We examined across-hospital variation and identified patient- and hospital-level factors associated with testing and prophylaxis using logistic regression models, accounting for clustering by hospital.
  
  
  RESULTS
  Among 12,687 included cases, 93% were female, 79% were <16 years old, 34% were non-Hispanic white, 38% were non-Hispanic black, 21% were Hispanic, and 52% had public insurance. Overall, 44% of adolescents received recommended testing (chlamydia, gonorrhea, pregnancy) and 35% received recommended prophylaxis (chlamydia, gonorrhea, emergency contraception). Across EDs, unadjusted rates of testing ranged from 6% to 89%, and prophylaxis ranged from 0% to 57%. Presence of a specialized sexual assault pathway was associated with increased rates of prophylaxis even after adjusting for case-mix and temporal trends (odds ratio 1.46, 95% confidence interval 1.15 to 1.86).
  
  
  CONCLUSIONS
  Evaluation and treatment of adolescent sexual assault victims varied widely across pediatric EDs. Adolescents cared for in EDs with specialized sexual assault pathways were more likely to receive recommended prophylaxis.
authors.affiliation: Divisions of General Pediatrics and Leonard Davis Institute of Health Economics, samantha_schilling@med.unc.edu.
authors.forename: Samantha
authors.initials: S
authors.lastname: Schilling
authors.affiliation: Leonard Davis Institute of Health Economics, Emergency Medicine, and.
authors.forename: Margaret
authors.initials: M
authors.lastname: Samuels-Kalow
authors.affiliation: Departments of Pediatrics, and Biostatistics and Epidemiology, and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Divisions of General Pediatrics and Departments of Pediatrics, and.
authors.forename: Philip V
authors.initials: PV
authors.lastname: Scribano
authors.affiliation: Leonard Davis Institute of Health Economics, Biostatistics and Epidemiology, and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.affiliation: Divisions of General Pediatrics and Leonard Davis Institute of Health Economics, Departments of Pediatrics, and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Joanne N
authors.initials: JN
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000706:statistics & numerical data; D002690:Chlamydia Infections / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission; D044363:Contraception, Postcoital / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000706:statistics & numerical data; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011258:Pregnancy Tests / Q000706:statistics & numerical data; D011902:Rape / Q000175:diagnosis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States