377 The Association Between Post-Assault Physical Appearance and Behaviors in the Emergency Department and Assault Types

Abstract

Study Objectives: Emergency department (ED) clinicians can help alleviate the psychological and physical impact of sexual assault through proper care of the sexual assault survivor. The physical exam serves to address medical needs, collect forensic evidence, and document observational findings; however, an exhaustive literature search revealed that no literature exists on whether specific post-assault appearance or behaviors can be linked to types of assault. The study aims to determine if a sexual assault survivor's post-assault appearance and behaviors are associated with types of assault. We hypothesize that post-assault appearance and behavior are linked to assault types.Methods: This was a retrospective, consecutive chart review of sexual assault survivors treated by sexual assault nurse examiners (SANEs) in the ED of a suburban teaching hospital from 1/1/2006 through 10/3/2010. Sexual assault survivors with documented appearance including calm, quiet, tense, restless, poor eye contact, and behaviors including reluctant to answer questions, posture/gait, agitated, twisting fingers, responsive to questions, crying, other, were studied with respect to whether they were assaulted by a known assailant or had a loss of consciousness. The chi-square test was used to compare groups (known versus unknown assailant or loss versus no loss of consciousness) with physical appearance and behaviors. Subjects with missing pertinent data were excluded from sub-analyses.Results: A total of 823 charts were reviewed. A higher percentage of “quiet” sexual assault survivors was assaulted by a known assailant (74.8%, n=249) than by an unknown assailant (25.2%, n=84; p <0.014). Of the SASs who were “twisting [their] fingers,” a higher percentage knew the assailant (59.4%, n=41) than did not (40.6%, n=28; p<0.039); a higher percentage was conscious during the assault (91.7%, n=58) than was not (8.3%, n=5; p<0.002). Additionally, a higher percentage of sexual assault survivors who were “reluctant to answer questions” was conscious during the assault (90.6%, n=55) than was not (9.4%, n=5; p<0.003). No significant relationships existed between other appearances or behaviors and knowing the assailant or having a loss of consciousness.Conclusion: Our results suggest that ED clinicians should be mindful that post-assault appearance and behaviors such as quietness, twisting fingers, and reluctance to answer questions may be associated with assault types such as relationship to assailant or loss of consciousness. Study Objectives: Emergency department (ED) clinicians can help alleviate the psychological and physical impact of sexual assault through proper care of the sexual assault survivor. The physical exam serves to address medical needs, collect forensic evidence, and document observational findings; however, an exhaustive literature search revealed that no literature exists on whether specific post-assault appearance or behaviors can be linked to types of assault. The study aims to determine if a sexual assault survivor's post-assault appearance and behaviors are associated with types of assault. We hypothesize that post-assault appearance and behavior are linked to assault types. Methods: This was a retrospective, consecutive chart review of sexual assault survivors treated by sexual assault nurse examiners (SANEs) in the ED of a suburban teaching hospital from 1/1/2006 through 10/3/2010. Sexual assault survivors with documented appearance including calm, quiet, tense, restless, poor eye contact, and behaviors including reluctant to answer questions, posture/gait, agitated, twisting fingers, responsive to questions, crying, other, were studied with respect to whether they were assaulted by a known assailant or had a loss of consciousness. The chi-square test was used to compare groups (known versus unknown assailant or loss versus no loss of consciousness) with physical appearance and behaviors. Subjects with missing pertinent data were excluded from sub-analyses. Results: A total of 823 charts were reviewed. A higher percentage of “quiet” sexual assault survivors was assaulted by a known assailant (74.8%, n=249) than by an unknown assailant (25.2%, n=84; p <0.014). Of the SASs who were “twisting [their] fingers,” a higher percentage knew the assailant (59.4%, n=41) than did not (40.6%, n=28; p<0.039); a higher percentage was conscious during the assault (91.7%, n=58) than was not (8.3%, n=5; p<0.002). Additionally, a higher percentage of sexual assault survivors who were “reluctant to answer questions” was conscious during the assault (90.6%, n=55) than was not (9.4%, n=5; p<0.003). No significant relationships existed between other appearances or behaviors and knowing the assailant or having a loss of consciousness. Conclusion: Our results suggest that ED clinicians should be mindful that post-assault appearance and behaviors such as quietness, twisting fingers, and reluctance to answer questions may be associated with assault types such as relationship to assailant or loss of consciousness.