Screening for Victims of Sex Trafficking in the Emergency Department: A Pilot Program
Abstract
Introduction: Estimates suggest that hundreds of thousands of sex trafficking victims live in theUnited States. Several screening tools for healthcare professionals to identify sex trafficking victimshave been proposed, but the effectiveness of these tools in the emergency department (ED) remainsunclear. Our primary objective in this study was to evaluate the feasibility of a screening survey toidentify adult victims of sex trafficking in the ED. We also compared the sensitivity of emergencyphysician concern and a screening survey for identifying sex trafficking victims in the ED anddetermined 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 priorto informing the physician of the survey results. A “yes” answer to any question or physician concernwas 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. Demographicand 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 sextrafficking. Sensitivity of the screening survey (100%, 95% CI [74%-100%]) was better than physicianconcern (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 thescreening 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 appearsto have greater sensitivity than physician concern, and a single screening question may be sufficient toidentify all adult victims of sex trafficking in the ED