Screening for victims of sex trafficking in the emergency department: A pilot program

Bryn Mumma, Marisa E. Scofield, Lydia P. Mendoza, Yalda Toofan, Justin Youngyunpipatkul, Bryan Hernandez

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Estimates suggest that hundreds of thousands of sex trafficking victims live in the United States. Several screening tools for healthcare professionals to identify sex trafficking victims have been proposed, but the effectiveness of these tools in the emergency department (ED) remains unclear. Our primary objective in this study was to evaluate the feasibility of a screening survey to identify adult victims of sex trafficking in the ED. We also compared the sensitivity of emergency physician concern and a screening survey for identifying sex trafficking victims in the ED and determined the most effective question(s) for identifying adult victims of sex trafficking. Methods: We enrolled a convenience sample of medically stable female ED patients, age 18-40 years. Patients completed a 14-question survey. Physician concern for sex trafficking was documented prior to informing the physician of the survey results. A "yes" answer to any question or physician concern was considered a positive screen, and the patient was offered social work consultation. We defined a "true positive" as a patient admission for or social work documentation of sex trafficking. Demographic and clinical information were collected from the electronic medical record. Results: We enrolled 143 patients, and of those 39 (27%, 95% confidence interval [CI] [20%-35%]) screened positive, including 10 (25%, 95% CI [13%-41%]) ultimately identified as victims of sex trafficking. Sensitivity of the screening survey (100%, 95% CI [74%-100%]) was better than physician concern (40%, 95% CI [12%-74%]) for identifying victims of sex trafficking, difference 60%, 95% CI [30%-90%]. Physician specificity (91%, 95% CI [85%-95%]), however, was slightly better than the screening survey (78%, 95% CI [70%-85%]), difference 13%, 95% CI [4%-21%]. All 10 (100%, 95%CI [74%-100%]) "true positive" cases answered "yes" to the screening question regarding abuse. Conclusion: Identifying adult victims of sex trafficking in the ED is feasible. A screening survey appears to have greater sensitivity than physician concern, and a single screening question may be sufficient to identify all adult victims of sex trafficking in the ED.

Original languageEnglish (US)
Pages (from-to)616-620
Number of pages5
JournalWestern Journal of Emergency Medicine
Volume18
Issue number4
DOIs
StatePublished - Jun 1 2017

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Human Trafficking
Hospital Emergency Service
Confidence Intervals
Physicians
Social Work
Electronic Health Records
Patient Admission
Surveys and Questionnaires
Sex Characteristics
Documentation

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Screening for victims of sex trafficking in the emergency department : A pilot program. / Mumma, Bryn; Scofield, Marisa E.; Mendoza, Lydia P.; Toofan, Yalda; Youngyunpipatkul, Justin; Hernandez, Bryan.

In: Western Journal of Emergency Medicine, Vol. 18, No. 4, 01.06.2017, p. 616-620.

Research output: Contribution to journalArticle

Mumma, B, Scofield, ME, Mendoza, LP, Toofan, Y, Youngyunpipatkul, J & Hernandez, B 2017, 'Screening for victims of sex trafficking in the emergency department: A pilot program', Western Journal of Emergency Medicine, vol. 18, no. 4, pp. 616-620. https://doi.org/10.5811/westjem.2017.2.31924
Mumma, Bryn ; Scofield, Marisa E. ; Mendoza, Lydia P. ; Toofan, Yalda ; Youngyunpipatkul, Justin ; Hernandez, Bryan. / Screening for victims of sex trafficking in the emergency department : A pilot program. In: Western Journal of Emergency Medicine. 2017 ; Vol. 18, No. 4. pp. 616-620.
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N2 - Introduction: Estimates suggest that hundreds of thousands of sex trafficking victims live in the United States. Several screening tools for healthcare professionals to identify sex trafficking victims have been proposed, but the effectiveness of these tools in the emergency department (ED) remains unclear. Our primary objective in this study was to evaluate the feasibility of a screening survey to identify adult victims of sex trafficking in the ED. We also compared the sensitivity of emergency physician concern and a screening survey for identifying sex trafficking victims in the ED and determined the most effective question(s) for identifying adult victims of sex trafficking. Methods: We enrolled a convenience sample of medically stable female ED patients, age 18-40 years. Patients completed a 14-question survey. Physician concern for sex trafficking was documented prior to informing the physician of the survey results. A "yes" answer to any question or physician concern was considered a positive screen, and the patient was offered social work consultation. We defined a "true positive" as a patient admission for or social work documentation of sex trafficking. Demographic and clinical information were collected from the electronic medical record. Results: We enrolled 143 patients, and of those 39 (27%, 95% confidence interval [CI] [20%-35%]) screened positive, including 10 (25%, 95% CI [13%-41%]) ultimately identified as victims of sex trafficking. Sensitivity of the screening survey (100%, 95% CI [74%-100%]) was better than physician concern (40%, 95% CI [12%-74%]) for identifying victims of sex trafficking, difference 60%, 95% CI [30%-90%]. Physician specificity (91%, 95% CI [85%-95%]), however, was slightly better than the screening survey (78%, 95% CI [70%-85%]), difference 13%, 95% CI [4%-21%]. All 10 (100%, 95%CI [74%-100%]) "true positive" cases answered "yes" to the screening question regarding abuse. Conclusion: Identifying adult victims of sex trafficking in the ED is feasible. A screening survey appears to have greater sensitivity than physician concern, and a single screening question may be sufficient to identify all adult victims of sex trafficking in the ED.

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