Original ContributionsLifetime sexual assault prevalence rates and reporting practices in an emergency department population*,**
Introduction
Sexual assault (SA) is the most rapidly growing violent crime in the United States.1 Female lifetime prevalence rates of SA in the general population are reported to range from 5% to 25%.2, 3, 4 Certain populations have much higher prevalence rates; lifetime rates of SA among adolescents have been reported up to 68%.5 Despite these rates, it is estimated that the majority of all SAs remain unreported. The National Crime Victimization Survey estimates that only 32% of the SAs occurring in 1994 were reported to the police.6
Women who present to emergency departments for medical care have been documented to have high prevalence rates of both partner violence and general violence.7, 8 In addition, Walch and Broadhead4 found that victims of an SA experience numerous short-term and long-term psychosocial and physical health effects and that they used medical services more frequently than nonvictims. Given this information, it is likely that the lifetime rates of SA may also be elevated in an urban ED population.
The objectives of this study were to measure the lifetime prevalence rate of SA in women presenting to the ED for care and to describe the reporting practices of SA victims. Our null hypothesis was that women presenting to an ED represent a high-risk group, and therefore would have a high lifetime prevalence rate of SA. We also hypothesized that SA would be underreported, consistent with prior studies.
Section snippets
Materials and methods
This cross-sectional survey was conducted at an urban Level I trauma center with an annual census of 55,000 patients. All English-speaking, noncritically ill female patients older than 18 years who presented to the ED for any reason during randomized 4-hour time blocks over a 4-week study period from July 15, 1997, through August 10, 1997, were eligible to participate. These time blocks represented all hours of the day and all days of the week.
Research assistants were trained by the primary
Results
Five hundred eighty-four women presented to the ED during the study period; 442 were eligible to participate. One hundred forty-two women were ineligible; 64 did not speak English, 23 had altered mental status, 20 were critically ill, 16 had been previously enrolled, 14 were presenting for a forensic examination following a recent SA, and 5 were overflow patients from the psychiatric ED. Of the 442 eligible patients, 360 patients (81%) consented and were enrolled in the study. Of the 82 women
Discussion
The lifetime prevalence rate of female SA in our study was 39%. Fifty-one percent of women presenting to our ED had a history of completed or attempted SA at some point during her life. These rates are higher than reported in other studies. One recent national study reported female SA lifetime prevalence rates of 18%.9 Family practice studies report lifetime prevalence rates for SA up to 15%.3, 4 Our findings are more consistent with results of at-risk patient or student samples, which
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Supported in part by the Rape Prevention and Education Fund, Public Health and Environment Services, Colorado Department of Public Health and Environment.
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Address for reprints and correspondence: Kim Feldhaus, MD, Department of Emergency Medicine–Mailcode #0108,Denver Health Medical Center,777 Bannock Street, Denver, CO 80204-4507, 303-436-7170; E-mail [email protected].