Sexual Assault and Forensic Exam Offers in the Emergency Department: A Retrospective Study

Area of Science:

• Medical Research
• Public Health
• Forensic Science

Background:

• Emergency departments (EDs) have a legal obligation to offer forensic exams to sexual assault survivors.
• Little is known about factors influencing the offer and acceptance of forensic exams in EDs that refer patients elsewhere.
• This study investigates patient characteristics associated with being offered a forensic exam in an ED without on-site services.

Purpose of the Study:

• To identify patient characteristics linked to the offer of a forensic exam for sexual assault survivors in an urban academic ED.
• To understand barriers to accessing forensic examinations for sexual assault victims.
• To inform the development of equitable care protocols.

Main Methods:

• Retrospective chart review of adult patients reporting sexual assault between 2017-2019.
• Data abstraction included demographics, insurance, psychiatric history, clinician concern for mental illness/substance use, and mode of arrival.
• Statistical analysis utilized chi-square tests and penalized logistic regression to determine factors associated with being offered a forensic exam.

Main Results:

• Of 108 eligible patients, 87% were offered a forensic exam.
• Patients offered exams were younger, more likely to arrive ambulatory, and less likely to have a psychiatric history.
• Clinician concern for acute mental illness or substance use was independently associated with *not* being offered a forensic exam (aOR 0.16, P = .02).
• A significant proportion (23.1%) of patients were uninsured.

Conclusions:

• Sexual assault survivors presenting with acute mental illness or substance use concerns are less likely to be offered forensic exams.
• Findings underscore the need for standardized ED protocols to ensure equitable access to forensic services.
• Advocacy is crucial for patients with behavioral health needs and those lacking insurance.