Date of Award

January 2019

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Shefali R. Pathy

Second Advisor

Seth Guller

Abstract

Survivors of sexual assault (SA) experience a range of physical and mental health consequences. Despite universal agreement that follow-up care improves outcomes, studies demonstrate only one-third of survivors receive assault related follow-up care. This study aims to describe the patient population presenting after SA, characteristics of their acute care, and rates of follow-up within one-year at two sites of the Yale New Haven Hospital, which includes an urban tertiary care hospital (York Street Campus, YSC), and its satellite community hospital (St Raphael Campus, SRC). A retrospective medical record review was conducted of patients older than 12 years presenting after sexual assault at emergency departments and outpatient clinics from Jan 2014 to Feb 2017. Differences between groups based on assault characteristics, such as assailant relation and substance use, were analyzed using Chi Square. Correlations with age were analyzed with linear regression. Of the 466 patient encounters that met inclusion, the mean patient age was 25.5 years (=12y); 95% were female; 46% were White and 35% were Black. The overall follow-up rate within one year after index visit was 35% (165/466). Patients older than 18 years had significantly lower rates of follow-up (23%, 73/318) than adolescents 13 to 18 years old (61%, 91/148) (p<0.05). Younger patients were more likely to receive recommended testing (p<0.05), and follow-up (p<0.001). Within adolescents, assault by a known individual significantly increases rates of follow-up (69% vs 41%, p<0.05), especially if by a family member (9/9, 100%). Follow-up after SA at our institution are low, consistent with the national average, and significantly lower in older survivors. Adolescent victims receive protocolized follow-up at a designated sex abuse clinic, are more likely to have the involvement of a case manager. Implementation of a standardized discharge protocol that involves follow-up at the Women’s Center—the ambulatory OBGYN clinic—and a designated care coordinator for navigation, may improve rates of follow-up of older survivors of SA.

Comments

This is an Open Access Thesis.

Download
Open Access

This Article is Open Access

Share

COinS