Chisolm-Straker Makini, Singer Elizabeth, Strong David, Loo George T, Rothman Emily F, Clesca Cindy, d'Etienne James, Alanis Naomi, Richardson Lynne D
Department of Emergency Medicine Institute for Health Equity Research Icahn School of Medicine at Mount Sinai Mount Sinai Queens New York New York USA.
Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA.
J Am Coll Emerg Physicians Open. 2021 Oct 12;2(5):e12558. doi: 10.1002/emp2.12558. eCollection 2021 Oct.
Patients with labor and sex trafficking experiences seek healthcare while and after being trafficked. Their trafficking experiences are often unrecognized by clinicians who lack a validated tool to systematically screen for trafficking. We aimed to derive and validate a brief, comprehensive trafficking screening tool for use in healthcare settings.
Patients were randomly selected to participate in this prospective study based on time of arrival. Data collectors administered 5 dichotomous index questions and a reference standard trafficking assessment tool that requires 30 to 60 minutes to administer. Data collection was from June 2016 to January 2021. Data from patients in 5 New York City (NYC) emergency departments (EDs) were used for tool psychometric derivation, and data from patients in a Fort Worth ED were used for external validation. Clinically stable ED adults (aged ≥18 years) were eligible to participate. Candidate questions were selected from the Trafficking Victim Identification Tool (TVIT). The study outcome measurement was a determination of a participant having a lifetime experience of labor and/or sex trafficking based on the interpretation of the reference standard interview, the TVIT.
Overall, 4127 ED patients were enrolled. In the derivation group, the reference standard identified 36 (1.1%) as positive for a labor and/or sex trafficking experience. In the validation group, 12 (1.4%) were positive by the reference standard. Rapid Appraisal for Trafficking (RAFT) is a new 4-item trafficking screening tool: in the derivation group, RAFT was 89% sensitive (95% confidence interval [CI], 79%-99%) and 74% specific (95% CI, 73%-76%) and in the external validation group, RAFT was 100% sensitive (95% CI, 100%-100%) and 61% specific (95% CI, 56%-65%).
The rapid, 4-item RAFT screening tool demonstrated good sensitivity compared with the existing, resource-intensive reference standard tool. RAFT may enhance the detection of human trafficking in EDs. Additional multicenter studies and research on RAFT's implementation are needed.
有劳动和性交易经历的患者在被贩卖期间及之后会寻求医疗保健服务。临床医生往往无法识别他们的贩卖经历，因为缺乏经过验证的工具来系统筛查贩卖情况。我们旨在开发并验证一种简短、全面的用于医疗保健环境的贩卖筛查工具。
根据到达时间随机选择患者参与这项前瞻性研究。数据收集人员提出5个二分法指标问题，并使用一个需要30至60分钟来实施的参考标准贩卖评估工具。数据收集时间为2016年6月至2021年1月。来自纽约市5个急诊科的患者数据用于工具的心理测量推导，来自沃思堡一个急诊科的患者数据用于外部验证。临床状况稳定的成年急诊科患者（年龄≥18岁）有资格参与。候选问题选自《人口贩卖受害者识别工具》（TVIT）。研究结果测量是根据参考标准访谈（TVIT）的解读来确定参与者是否有一生的劳动和/或性交易经历。
总体而言，4127名急诊科患者被纳入研究。在推导组中，参考标准确定36人（1.1%）有劳动和/或性交易经历呈阳性。在验证组中，12人（1.4%）经参考标准判断为阳性。快速贩卖评估法（RAFT）是一种新的包含4个条目的贩卖筛查工具：在推导组中，RAFT的敏感性为89%（95%置信区间[CI]，79%-99%），特异性为74%（95%CI，73%-76%）；在外部验证组中，RAFT的敏感性为100%（95%CI，100%-100%），特异性为61%（95%CI，56%-65%）。
与现有的资源密集型参考标准工具相比，快速的、包含4个条目的RAFT筛查工具显示出良好的敏感性。RAFT可能会提高急诊科对人口贩卖的检测能力。还需要进行更多的多中心研究以及关于RAFT实施情况的研究。
