Increasing emergency department admissions in U.S. for child sexual abuse

[November 05, 2019]  By Linda Carroll

(Reuters Health) - The rate at which children are being admitted to U.S. emergency departments for sexual abuse almost doubled between 2010 and 2016, a new study finds.

Nationwide emergency department data show that admissions of youngsters under age 18 to EDs for sexual abuse rose from just under six per 100,000 children to nearly 12 per 100,000, researchers report in JAMA Pediatrics.

It's not clear why the numbers are rising, said study leader Jesse Helton, from the School of Social Work at the College of Public Health and Social Justice at St. Louis University in Missouri.

"The data we used are very limited in that regard," Helton said in an email. But "we can speculate. Particularly in rural areas or communities without a specialized pediatrician or Child Advocacy Center, (emergency rooms) may increasingly be relied on to coordinate the medical care of survivors and help with the forensic work for child protective services and the courts."

The rise could also be related to increases in human trafficking, he said.

Helton and his colleagues analyzed date from the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project, the largest publicly available all-payer database of emergency department visits.

Focusing on data from 2010 through 2016, the researchers determined that roughly 190 million children were admitted to EDs in the U.S. during those seven years. Of the 46,993 who were admitted for confirmed sexual abuse, 85.14% were girls and 44.75% were ages 12 to 17.

The number of emergency department admissions for child sexual abuse rose from 5,138 in 2010 to 8,818 in 2016, which meant that admissions increased from 6.93 per 100,000 children in 2010 to 11.97 per 100,000 in 2016.

The numbers could easily be an underestimate.

"These were counts of confirmed cases of child sexual abuse, not allegations or suspected cases," Helton said. "In general, child sexual abuse cases are underreported in the general population."

The new findings "highlight the fact that this is an ongoing and important public health issue in our country, said Dr. C. Anthoney Lim, director of pediatric emergency medicine at the Mount Sinai Health System in New York.

Lim agreed the new findings may be an underestimate. "They looked for diagnostic codes for child sexual abuse that were confirmed, whereas in practice many patients come to the emergency department with abuse are often coded as suspected rather than confirmed," Lim said. "So they might actually be missing a significant number."

Moreover, by limiting their search to those under 18, they could be missing many who are victims of sex trafficking, Lim said. "There are a significant number in the 18 to 21 range who are also seen in ERs," he added.

As for the rise in the number of children admitted to the ER for sexual abuse, Lim suspects that may at least partly be due to more public awareness.

"I think it has to do with increased awareness and education among providers as well as among the children themselves," Lim said.

Lim hopes the new findings will spark more interest in this subject. "It's a hypothesis generating study that hopefully will lead to more studies," he said.

SOURCE: http://bit.ly/2WRJFAJ JAMA Pediatrics, online November 4, 2019.

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