Jones Jeffrey S, Rossman Linda, Wynn Barbara N, Dunnuck Chris, Schwartz Natalie
Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus, 100 Michigan Street NE, Grand Rapids, MI 49503-2560, USA.
Acad Emerg Med. 2003 Aug;10(8):872-7. doi: 10.1111/j.1553-2712.2003.tb00631.x.
To compare the characteristics of sexual assault in pubertal girls (<18 years old) and adults in a community-based population of women presenting to an urban sexual assault clinic.
This case-series analysis evaluated consecutive female patients presenting to a sexual assault clinic during a three-year study period. The clinic is associated with a university-affiliated emergency medicine residency program and is staffed by forensic nurses trained to perform medicolegal examinations using colposcopy with nuclear staining. Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. Data from the two patient groups (adolescents vs. women > or =18 years of age) were analyzed using chi-square test and t-test.
A total of 766 cases were identified: 43% of the victims were 13 to 17 years old (mean 15.0 years old), and 57% were older than 17 years old (mean 30.8 years old). Adolescents were more likely to be assaulted by an acquaintance or relative (84% vs. 50%, p < 0.001) and to delay medical evaluation (17 hours vs. 12 hours, p < 0.001) than were older women. Adolescent sexual assault was less likely to involve weapons or physical coercion (29% versus 57%, p < 0.001) and was associated with fewer nongenital injuries (33% vs. 55%, p < 0.001). Adolescents had a greater frequency of anogenital injuries (83% vs. 64%, p < 0.001), however, compared with older women. Common sites of injury in adolescents were posterior, including the fossa navicularis, hymen, fourchette, and labia minora. The injuries showed consistent topologic features, varying with the site and nature of tissue. Adult victims of sexual assault had a less consistent pattern of anogenital injuries with fewer hymenal injuries, greater injury to the perianal area, and widespread erythema.
Of women presenting to an urban sexual assault clinic, 43% were adolescents. The epidemiology of sexual trauma and the pattern of anogenital trauma in this age group are unique and may pose special challenges to emergency health care providers.
比较前往城市性侵犯诊所就诊的社区女性人群中青春期女孩（<18岁）和成年人性侵犯的特征。
本病例系列分析评估了在为期三年的研究期间前往性侵犯诊所就诊的连续女性患者。该诊所与一所大学附属的急诊医学住院医师培训项目相关联，工作人员为经过培训的法医护士，他们使用带有核染色的阴道镜进行法医学检查。使用标准化分类系统记录患者的人口统计学特征、侵犯特征和损伤模式。使用卡方检验和t检验分析两组患者（青少年组与年龄≥18岁的女性组）的数据。
共识别出766例病例：43%的受害者年龄在13至17岁之间（平均15.0岁），57%的受害者年龄超过17岁（平均30.8岁）。与成年女性相比，青少年更有可能被熟人或亲属侵犯（84%对50%，p<0.001），且延迟医疗评估的时间更长（17小时对12小时，p<0.001）。青少年性侵犯较少涉及武器或身体胁迫（29%对57%，p<0.001），且非生殖器损伤较少（33%对55%，p<0.001）。然而，与成年女性相比，青少年肛门生殖器损伤的频率更高（83%对64%，p<0.001）。青少年常见的损伤部位在后部，包括舟状窝、处女膜、会阴系带和小阴唇。损伤表现出一致的拓扑特征，随组织部位和性质而变化。成年性侵犯受害者的肛门生殖器损伤模式不太一致，处女膜损伤较少，肛周区域损伤较多，且有广泛的红斑。
在前往城市性侵犯诊所就诊的女性中，43%为青少年。该年龄组性创伤的流行病学和肛门生殖器创伤模式具有独特性，可能给急诊医疗服务提供者带来特殊挑战。
