Traumatic Injuries in Sexual Assault Patients in the Emergency Department

Denise McCormack MD, MPH; Sushi Subburamu, MD; Glenda Guzman, DHSc, PA-C; Carmen Calderon, LCSW; Ruchika Darapaneni, MSIV; Robert Lis, MSIV; Niloofar Sima, MSIV; Jeremy Sperling, MD; Jill Corbo, MD

Disclosures

Western J Emerg Med. 2022;23(5):672-677. 

In This Article

Abstract and Introduction

Abstract

Introduction: The emergency department (ED) is at the forefront for treatment of sexual assault patients. Many require treatment for injuries sustained during the assault, ranging from mild to severe. Our objective in this study was to characterize types of injuries associated with sexual assault and identify associated factors.

Methods: We reviewed ED charts from an inner-city trauma center and nearby community hospital from 2019–2020 for patients age ≥13 years with a chief complaint of sexual assault. We used descriptive statistics, chi square, and logistic regression to characterize demographics and identify factors associated with trauma.

Results: A total of 157 patients met inclusion criteria. The mean age was 27.9 years old (range 13–79 years) and 92.4% were female. Adult patients (age >18 years) comprised 77.5% of assaults vs adolescents (age 13–18 years) at 22.3%. Most patients presented to the trauma center compared to the community hospital (69.4% vs 30.6%). The assailants were reported as 61.2% acquaintance, 22.9% stranger, and 15.9% intimate partner. A forensic rape kit was performed in 92 (58.6%) cases. The patient was intoxicated with alcohol in 39 (24.8%) cases, and 22 (14%) patients reported drug-facilitated assault where an unknown substance was given to them. Alcohol (P = 0.95) and drug-facilitated assault (P = 0.64) did not change the occurrence of injuries. Fifty-seven (36.3%) patients exhibited physical trauma on presentation. Forty-five (28.6%) patients had minor injuries of abrasions, lacerations, or contusions. Major trauma was defined as fracture, brain injury, hemorrhage, strangulation, or injury requiring surgical consultation. There were 12 patients with major trauma consisting of fracture injury or nonfatal strangulation. None of the patients required admission. Sexual assault by an intimate partner (odds ratio [OR] 2.6; 95% CI: 1.1–6.5) and being an adult patient compared to adolescent (OR 3.0; 95% CI, 1.1–7.7) was significantly associated with physical trauma. Sexual assault by an intimate partner was also associated with nonfatal strangulation (OR 4.0; 95% CI, 1.1–15.4).

Conclusion: Physical injuries that resulted from sexual assault were mostly minor and occurred in 36% of rape victims. Intimate partner violence was found to be associated with physical trauma as well as nonfatal strangulation. Overall, this study helps us to understand key factors associated with sexual violence.

Introduction

In the United States, approximately 52 million women and 27 million men have experienced sexual assault (SA) in their lifetime.[1] The emergency department (ED) remains the most common place where SA patients first seek out comprehensive care to receive emergency contraception, prophylaxis against sexually transmitted infections, completion of a forensic rape kit, and treatment for their injuries. Studies have shown that 30–80% of SA patients present to the ED with traumatic injury.[2–4] However, there is conflicting evidence regarding the severity of these injuries.[5–6]

Several prior studies suggested that traumatic injuries during sexual assault were more likely to occur when a stranger was the assailant.[7–9] However, other studies determined that a significant injury was more likely to happen when the assailant was an intimate partner (IP).[10–11] In this study we evaluated the likelihood of SA being committed by an IP, acquaintance, or stranger, and whether this was related to the patient experiencing traumatic injuries.

Sexual assaults are frequently associated with drug-facilitated sexual assault (DFSA), illicit drugs, or alcohol. Drug-facilitated sexual assault has prevalence as high as 20.9% and is defined as when a drug is given to incapacitate the victim. Common DFSA drugs are gamma hydroxybutyrate, ketamine and benzodiazepines.[12–15] Over-the-counter agents such as diphenhydramine (Benadryl) and Visine eye drops have also been reported.[16–17] Alcohol intoxication in comparison to DFSA is more frequent and is typically the most common substance associated with sexual assault, occurring in 33–60% of cases.[18–19] In this study, we aimed to determine how frequently SA patients sustained traumatic injuries when either alcohol or DFSA was involved.

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