Sexually assaulted teens getting subpar ER care

Many sexually assaulted teens don't get the recommended tests and treatments when they visit the emergency room for care.

A new study shows testing and treatments that can help prevent pregnancy and venereal diseases varied widely when protocols at 38 children's hospitals were analyzed, with anywhere from zero to 90 percent of victims getting treated and/or tested. The report, from researchers from the Children's Hospital of Philadelphia, is based on 2004-13 data on almost 13,000 teens and is published in Pediatrics.

On average, 44 percent of teen assault victims received recommended tests and about one-third received preventive treatments, according to the researchers. Rates for both varied by hospital and were lowest for younger patients.

Other studies have found low emergency room testing and treatment rates for sexually assaulted adults based on guidelines by the U.S. Centers for Disease Control and Prevention.

Teen sexual assault is common - in the United States, up to 25 percent of girls and 10 percent of boys are sexually abused or assaulted by the age of 18, the researchers said. Almost 11 percent of high school girls and four percent of boys reported having been raped in a 2013 government survey.

The U.S. Centers for Disease Control and Prevention and pediatricians recommend testing sexually assaulted teens for several venereal diseases and giving preventive antibiotics for chlamydia and gonorrhea. Other advice includes testing for hepatitis B in unvaccinated patients and for HIV and syphilis in areas where those diseases are prevalent, and providing pregnancy tests and emergency contraception.

Subpar treatment puts teens at risk for infections including HIV, chlamydia, and gonorrhea, along with unwanted pregnancies. The results highlight a need for better awareness of testing and treatment guidelines from the American Academy of Pediatrics and the CDC, the study authors said.

Explanations for the gaps in care? Some teens may not have been tested or treated if an assault did not involve intercourse, the researchers say. Also, some hospitals might not test teens who delay seeking care, although most experts recommend doing so anyway to detect pre-existing and new infections.

A Pediatrics editorial notes that some teens may decline testing and treatment, or may seek care in outpatient clinics, so the true rates of under-treatment are unknown.

The researchers recommend standardizing medical care for sexually assaulted teens, along with increasing guidelines awareness. In addition, doctors need to identify and address barriers to providing these patients with the appropriate medical care, the editorial says.