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Emergency Evaluation of Children When Sexual Assault Is Suspected

Three reports in this issue of Pediatrics address the challenge of evaluating acute sexual assault of children and adolescents. The first, by Floyed et al, discusses using a screening tool in the pediatric emergency department to determine whether a child can be referred to a different (less-busy or more-appropriate) practice setting for evaluation.1 This is a reasonable approach, because many children report abuse that occurred days, weeks, or years before presentation to the emergency department. Two caveats, however, should be noted. The first comes from the other 2 studies in this issue.2,3 Both of those studies report an occasional incident in which forensic testing revealed evidence in assault cases several days after the events occurred. Another consideration is that, although a child’s disclosure of sexual abuse in the distant past might not be perceived as a medical emergency by health care providers, it often is perceived as a major emotional crisis by the child’s family members. Family members often experience the disclosure of sexual abuse as if a bomb has exploded in their midst. If these children are not seen in an acute manner, then appropriate referrals should be made to provide the needed support for the children and families. In addition, reports to child protection authorities should be made in a timely manner. The studies by Thackeray et al2 and Girardet et al3 add to the growing literature on the importance of forensic evidence collection in the era of DNA typing. Several studies have shown that collection of forensic evidence in child sexual assault cases is seldom helpful if the assault occurred 24 hours before evaluation.4–6 These 2 studies, however, indicate that, in a small number of cases, important forensic evidence of sexual assault can be obtained beyond the 24-hour window. The 2 studies confirm that fewer younger children have positive rape kit results. Because most young children have a difficult time reporting and testifying about their assaults, however, positive forensic evidence becomes especially important.