Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Pediatric sexual assault (SA) victims are a special population eligible for HPV vaccination at the age of 9 years. National clinical practice guidelines advise clinicians to address HPV during emergency department (ED)-based SA care and at follow-up. At our institution, addressing HPV among suspected SA victims was highly variable, and HPV counseling was subsequently recommended on an ED-based acute SA clinical pathway as standard care. The aim of this study was to determine the proportion of age-eligible SA victims who received HPV counseling, determine victim characteristics associated with addressing HPV during SA care, and identify barriers to addressing HPV in the ED.
This study used a retrospective chart review of 448 pediatric SA victims presenting to the ED for acute postassault care.
HPV was discussed in 10 of 56 (18%) and 37 of 49 (76%) cases in the control versus intervention groups, respectively. To verify vaccination status, caregiver recall was relied upon for 32 of 56 patients in the control group (57%) and 24 of 49 patients in the intervention group (48.9%). Factors associated with failure to discuss HPV during postassault care were younger age at encounter (OR = 0.78, 95% CI [0.67, 0.90], p < 0.001), verbal report of vaccination status verification (OR = 2.98, 95% CI [1.51, 6.01]), and male gender of the victim (OR = 3.35, 95% CI [1.20, 11.94]).
Significant barriers to addressing HPV in the ED setting exist, most significantly reliance on caregiver recall to guide vaccination administration, raising concern for overvaccination and undervaccination.
1Department of General Pediatrics, Alfred I. DuPont Hospital for Children;
2Sidney Kimmel Medical College at Thomas Jefferson University;
3Hobart, William and Smith Colleges;
4Delaware-CTR ACCEL Program, Nemours/Alfred I. DuPont Hospital for Children;
5Department of Emergency Medicine, Alfred I. DuPont Hospital for Children.
Sarah Benyo was supported by the Nemours Foundation under the Department of Biomedical Research, Office of Research Educational Programs, Summer Undergraduate Research Program.
This work was supported by an Institutional Development Award from the National Institute of General Medical Sciences of the National Institutes of Health under Grant number U54-GM104941 (PI: Binder-Macleod).
The authors declare no conflict of interest.
Correspondence:Stephanie Anne Deutsch, MD, MS, Division of General Pediatrics, Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, Delaware 19803. E-mail: Stephanie.email@example.com.
Received February 8, 2018; accepted for publication March 31, 2018.