Journal Review: Routine pharyngeal cultures may not be useful in pediatric victims of sexual assault
Journal Review
Brown SL, Peck KR, Watts, DD. Routine pharyngeal cultures may not be useful in pediatric victims of sexual assault. J Emerg Nurs 2000; 26:306-311.
Routine oral cultures in pediatric victims of sexual assault is time-consuming, invasive, and costly, and there is no significant benefit to this practice, suggests this study from Inova Fairfax Hospital in Falls Church, VA. Records of 451 pediatric sexual assault examinations were reviewed, all of which had oral, vaginal or penile, and anal culture results. There were zero positive oral culture results in the sample.
Because of these findings, the policies of the ED’s sexual assault nurse examiner program have been changed. Any patient who alleges oral copulation will still have an oral culture done, but the routine collection of specimens for oral cultures has been discontinued. They note the following exceptions:
• Children in whom an inadequate history or a history of questionable value has been received.
• Cases in which the history is unknown because of mental incapacitation, age, or developmental level of the child.
• Possible drug use, either voluntary or involuntary, related to altered mental status and an inability to recall details of the event.
"Not only are oral cultures time-consuming, they represent one more probing’ the child may be required to undergo," wrote the researchers. "They also are less likely to provide definitive findings, even in a best-case scenario, given the fact that time may have elapsed, the child may have eaten, had something to drink, or have brushed his or her teeth."
Although the monetary savings (estimated at approximately $40 per patient) might seem insignificant, it will help to contain costs, the researchers say.
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