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Sexual assault (SA) is a prevalent public health issue that involves the violation of human rights and has various short-term and long-term impacts on health. Adolescents and young adults have the highest rates of SA victimization of any age group. Adolescent survivors of SA often present to the pediatric Emergency Department (ED), where the care they receive may impact their future mental and physical health trajectories. This study aimed to explore the health outcomes of adolescent survivors of SA, as measured by their subsequent emergency healthcare utilization for mental and sexual health concerns following an initial visit for SA.
This retrospective cohort study utilized the Pediatric Health Information System (PHIS) database, which contains clinical data from 49 children’s hospitals. Thirty hospitals reported complete data during the study period and were included. The cohort population included adolescents aged 11-18 years old seen at a PHIS hospital with a primary diagnosis of SA between 2010-2017. The control population included age-matched, biological sex-matched adolescents seen at the same hospital during the same time-frame for a minor injury, including sprain or contusion. Participants were followed prospectively in the PHIS database through 2020 (or until age 22); subsequent ED visits during the follow-up period for suicidal ideation/attempt, sexually transmitted infection (STI), pelvic inflammatory disease (PID), or pregnancy were identified by billing diagnosis codes. The risk of each outcome was compared between the SA and control populations using Cox proportional hazards models, with calculation of hazard ratios (HR) with 95% confidence intervals (95% CI).
The study population consisted of 20,434 adolescents (10,217 SA cohort patients and 10,217 controls). The majority (91.7%) were female. During the study period, 8.2% of participants initially seen for SA returned to the ED due to suicidal ideation/attempt, compared to 4.6% of controls. ED return visit rates for sexual health concerns in the SA versus control groups were 1.9% versus 1.5% for STI, 2.3% versus 0.9% for PID, and 1.7% versus 1.1% for pregnancy. Adolescents in the SA cohort had a significantly higher risk of returning to the ED for suicidal ideation/attempt (HR 3.49, 95% CI 3.05-4.00), STI (HR 1.89, 95% CI 1.48-2.43), PID (HR 3.86, 95% CI 3.11-7.79) and pregnancy (HR 2.31, 95% CI 1.76-3.03), compared to controls.
In this retrospective cohort study of over 20,000 patients, adolescents evaluated in the ED for SA were at significantly greater risk for returning to the ED for suicidality and sexual health concerns, compared to controls. This is the first large-scale study to use healthcare systems data to demonstrate an increased frequency of adverse health outcomes requiring emergency care among adolescent survivors of SA across multiple hospitals. These findings highlight that adolescent survivors of SA experience health-related disparities, underscoring the need for increased allocation of both research funding and clinical resources to improve their emergency and follow-up care, as well as emphasizing the importance of advocating to bolster sexual violence prevention efforts.