Temporal Patterns of Sexual Assault Presentations in U.S. Emergency Departments: Implications for Staffing and Forensic Readiness.

BACKGROUND

Sexual assault (SA) remains a major public health issue, yet only a fraction of survivors seeks acute medical care in emergency departments (EDs). Although previous studies describe demographic disparities among SA survivors, national patterns of ED arrival timing and their operational implications for emergency care systems remain poorly characterized.

STUDY

OBJECTIVES

To characterize the demographic and temporal patterns of ED presentations for SA in the United States.

METHODS

We conducted a repeated cross-sectional study using the Epic Cosmos database, including U.S. ED encounters related to SA from January 1, 2016 through December 31, 2024. Demographic characteristics and arrival patterns were compared with those of all other ED visits using odds ratios (ORs) with 95% confidence intervals (CIs). Temporal distributions by day of week and 6-h arrival intervals were analyzed using chi-square testing and standardized Pearson residuals.

RESULTS

Among 391,352,267 ED visits, 245,475 (0.06%) involved SA evaluation. Patients presenting with SA were disproportionately adolescents and young adults, female, Medicaid-insured, and from minoritized racial groups. Overnight arrivals (00:00-05:59) had significantly higher odds of SA presentation (OR, 1.45; 95% CI, 1.43-1.47), with peak presentations occurring on Sundays and Saturdays overnight. Morning presentations were consistently below expected levels. In 2016, 16% of patients presenting with SA arrived by ambulance; by 2024, this number had increased to 18%.

CONCLUSION

SA presentations revealed distinct demographic and temporal patterns with important operational implications for EDs. Young and socially vulnerable populations are disproportionately affected. The concentration of presentations during overnight weekend hours highlights the need for expanded access to trauma-informed forensic services, including SA Nurse Examiner coverage and prehospital education, especially during high-demand periods.