Original Contributions
Analysis of 1,076 cases of sexual assault

Presented at the Society for Academic Emergency Medicine, annual meeting, Denver, CO, May 1996.
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Abstract

Study objective: Rates of sexual assault are increasing, and evidence exists that its demographics and characteristics are changing. The purpose of our study was to describe victim, assailant, assault, and treatment characteristics for sexual assault victims and to provide descriptive data on the evidentiary examination. Methods: Prospective data were collected on all sexual assault victims presenting to an urban Level I trauma center from January 1992 to December 1995 for treatment and evidentiary examination. Data from crime laboratory records were retrospectively reviewed. Results: One thousand one hundred twelve patients presented after a sexual assault. A total of 1,076 (97%) patients consented to the medical and evidentiary examination and were enrolled in the study. Age ranged from 1 to 85 years (mean, 25 years; median, 23 years), with 96% (1,036/1,076) female and 4% (41/1,076) male victims. The number of assailants was greater than 1 in 20% (208/1,044) of cases, and the assailant was a stranger only 39% (409/1,094) of the time. Force was used in 80% (817/1,027) of reported assaults, and in 27% (275/1,014) of cases a weapon was present. Vaginal intercourse was involved in 83% (851/1,023) of female victims. Oral assault was involved in 25% (271/1,053)of all cases, and anal penetration was involved in 17% (178/1,058) of all cases. Overall, general body trauma was seen 67% (621/927) of the time, and genital trauma occurred in 53% (388/736) of cases. Twenty percent (147/1,712) of patients had no trauma noted on examination. Sperm were noted on the emergency department wet mount in only 13% (93/716) of the victims, and of the 612 cases with both ED sperm data and crime laboratory semen data available, evidence of sperm and semen were found 48% (296/612) of the time by either. Conclusion: Health care professionals should be aware that general body trauma is common, that the assailant is often someone known to the victim, and that evidence of semen is commonly found by the crime laboratory even when it is not found in the ED analysis of a wet mount. [Riggs N, Houry D, Long G, Markovchick V, Feldhaus KM. Analysis of 1076 cases of sexual assault. Ann Emerg Med. April 2000;35:358-362.]

Introduction

The Federal Bureau of Investigation in 1994 estimated that 1 of 3 women and 1 of 7 men in the United States will be raped at some point in their lifetime.1 The incidence and prevalence of sexual assault is increasing, in part because of increased reporting of such crimes.

The acute treatment of sexual assault victims is most frequently handled in the setting of an emergency department, where a specialized and trained team of providers is available 24 hours per day.2 The physician’s primary function is not to determine whether a sexual assault has occurred because this is a legal determination but primarily to address the medical and psychologic needs of the patient.3 A secondary purpose of the examination is evidentiary documentation and collection. Emergency physicians thus need to be aware of the epidemiology of sexual assault victims and their associated injuries.

In 1992, Magid et al4 described changes in the epidemiology of sexual assault treated in the ED, including increases in the incidence of sexual assault, in the percentage of assailants known to their victims, and in the incidence of oral and anal assault. Since then, no study has described victim, assailant, assault, and treatment characteristics. Furthermore, few sexual assault studies have reported the results of the evidentiary examination.

The purpose of our study was to describe victim, assail-ant, assault, and treatment characteristics for sexual assault victims and to provide descriptive data on the evidentiary examination.

Section snippets

Materials and Methods

This study was conducted in an urban Level 1 trauma center. All sexual assault victims who report the crime to law enforcement within the city and county of Denver are triaged to this ED for a medical and evidentiary examination. This examination is always performed by the emergency medicine resident on duty during the shift.

All patients with a presenting chief complaint of sexual assault were eligible for this study. Patients who refused the evidentiary examination and those whose evidentiary

Results

One thousand one hundred twelve patients presented during the study period after a sexual assault. The data collection form was unavailable or the patient refused the evidentiary examination in 36 cases. A total of 1,076 (96.8%) subjects consented to the medical and evidentiary examination and were enrolled in the study. Unless otherwise noted, data were present in at least 93% of cases for all variables given. There were 1,035 (96.2%) female and 41 (3.8%) male subjects. Age ranged from 1 to 85

Discussion

Several demographic features of sexual assault victims and sexual assaults have changed in the past 20 years. Sexual assault victims are still much more likely to be female (96.2%) than male (3.8%). However, the percentage of sexual assaults perpetrated by strangers has declined.

Thirty-eight percent of our female sexual assault victims were assaulted by someone with whom they had an established relationship, and 24% were assaulted by a first-time acquaintance. A complete stranger was implicated

Acknowledgements

We thank Tasha Markovchick for her assistance with data entry.

References (18)

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Address for reprints: Debra Houry, MD, MPH, Department of Emergency Medicine, Mailcode #0108, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204; fax 303-436-7541; E-mail [email protected] .

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