Assailants' Sexual Dysfunction During Rape: Prevalence and Relationship to Genital Trauma in Female Victims

Background: Partial or complete failure to maintain an erection sufficient for coitus is known to occur in a proportion of sexual assailants during the rape episode. Objective: The purpose of this study was to determine whether the presence of coercion, physical violence, and genital injury associated with sexual assaults is influenced by the assailant's erectile impotence. Methods: This prospective, observational study evaluated consecutive female patients presenting to a free-standing urban sexual assault clinic during a 3-year study period. Sexual assault victims presenting directly to four downtown emergency departments (EDs) are routinely referred to the clinic for evaluation after triage and initial assessment. The clinic is associated with a university-affiliated emergency medicine residency program and is staffed by forensic nurses trained to perform medical-legal examinations. The primary outcome was to compare the frequency of anogenital findings documented in women whose assailant experienced no erectile dysfunction vs. those victims who reported erectile impotence in the assailant. Results: During the study period, 569 sexual assault victims were eligible to participate in the study; 47 (8.3%) reported that their assailants had experienced erectile impotence. Except for assailant age, the two victim groups were comparable in terms of marital status, alcohol and drug use, known assailant, and time to physical examination. In attacks where erectile dysfunction occurred, there was a higher incidence of physical coercion (60% vs. 32% without physical coercion, p < 0.001) and subsequent non-genital trauma (72% vs. 46%, respectively, p < 0.001). Thirty-two women (68%) had documented anogenital trauma despite the assailant having erectile dysfunction. There was no significant difference in the overall pattern of anogenital injury between the two groups (χ² = 9.1, p = 0.036). Conclusion: Erectile impotence occurred in up to 8% of sexual assailants during the rape episode. Despite this erectile dysfunction, the majority of sexual assault victims sustained anogenital trauma. In the attacks with erectile impotence, there was a higher incidence of intra-rape violence and subsequent non-genital injuries.     

Why women don't report sexual assault to the police: the influence of psychosocial variables and traumatic injury

The purpose of this study was to identify the variables that acutely influence reporting practices in female sexual assault victims presenting to an urban clinic or Emergency Department. We conducted a cross-sectional survey of consecutive female victims during an 18-month study period. Patient demographics, assault characteristics, and injury patterns were recorded in all eligible patients using a standardized classification system. At the completion of the forensic examination, victims were asked to complete a psychosocial questionnaire designed to determine specific reasons why women reported or did not report their sexual assault to police. During the study period, 424 women were eligible to participate in the study; 318 (75%) reported the sexual assault to police. One hundred six (25%) did not file a police report, but consented to a medical-legal examination. Women not reporting sexual assault were typically employed, had a history of recent alcohol or drug use, a known assailant, and prolonged time intervals between the assault and forensic evaluation (p < 0.001). There were no differences in the extent of non-genital injuries or anogenital injuries between the two groups. Thirty-six percent (152/424) of the eligible population agreed to complete the questionnaire. Only three of the 20 psychosocial variables examined were found to be significantly different in women not reporting sexual assault compared to reporters. The reasons for not reporting were primarily environmental factors (prior relationship with assailant) rather than internal psychological barriers (shame, anxiety, fear).     

Sexual assault victims in the emergency department: analysis by demographic and event characteristics

The objective of this study was to analyze demographic and event characteristics of patients presenting to the Emergency Department (ED) for evaluation after sexual assault, using a Sexual Assault Nurse Examiner standardized database. Data were prospectively collected as part of the Sexual Assault Nurse Examiner program at an urban teaching hospital. This study reviewed all ED patient records with a complaint of sexual assault between January 1, 2000 and December 31, 2004. Data were collected on 1172 patients; 92.6% were women, with a mean age of 27 years. The sample was 59.1% black, 38.6% white, and 2.3% “Other.” Black victims of sexual assault were significantly more likely to be young (25 years or less) than Whites. Over half (54%) reported involvement of drugs or alcohol during the event. Fifty-three percent knew their assailant(s), and black and young patients were significantly more likely to know the perpetrator(s). Threats of force were common (72.4% of sample), and multiple assailants were uncommon (18.1% of sample). Physical evidence of trauma was present in more than half (51.7%), with increased rates among Whites and older persons. Multivariate analysis showed that race, age, threats, and substance use during the event were independent risk factors for evident trauma on physical examination. Survivors of sexual assault who present to the ED are overwhelmingly female, relatively young, often know the perpetrator of the event, and are likely to be threatened and show signs of physical trauma. Differences between patients according to demographic and event characteristics may have important implications for ED management and treatment plans.     

Risk factors for recent domestic physical assault in patients presenting to the emergency department

Objective: To identify risk factors for physical or sexual assault as a result of domestic violence in patients presenting to the ED. Methods: Backward prevalence study of two urban teaching hospital emergency departments measuring the 1‐year period prevalence, acute incidence of ED presentation and risk factors of domestic physical assault. Results: Of the 1326 patients (62% female) completing the study, 115 (9% CI 7%, 10%) reported assault by a partner or ex‐partner within the preceding 12 months and 31 (2% CI 1.6%, 2.3%) reported domestic physical assault as the cause of their presentation. Risk factors for recent domestic physical assault included female gender (prevalence rate ratio, (PRR) 1.5 CI 1.0 2.2), age 17 to < 25 years (PRR 6.8 CI 1.7 27.7) or 25 to < 35 years (PRR 5.7 CI 1.4 23.0), past presentation to an ED for assault (PRR 2.5 CI 1.7 3.7) and a past history of child abuse (PRR 2.2 CI 1.5 3.1). There was no association between health service utilization or mental illness and the reporting of recent domestic physical assault. Conclusion: The study characterizes ED patients at high risk of injury from domestic violence.     

The prevalence of occupational injuries in EMTs in New England

OBJECTIVE: To characterize the prevalence and morbidity of injuries to emergency medical technicians EMTs) in New England [United States]. DESIGN: A survey was mailed to a 2% random sample of all registered EMTs in the six New England States. The identity of the EMTs remained anonymous, and a second mailing was used to improve return rate. The EMTs were requested to recall events that occurred during the previous six months. RESULTS: A total of 439 of the 786 (56%) surveys were returned representing 13,875 hours of duty time in the six-month period. Seventy-one percent of the EMTs were male with a mean age of 35 years. Sixty-six percent were basic-EMTs. Injury attack rates (number of injuries/100 EMTs/6 months) were: stress, 11.2; back, 10.5; extremity, 9.8; assault, 8.4; ambulance collision, 4.1; hearing loss, 2.5; and eye injury, 1.4. Twelve percent of the EMTs were injured more than once in the six-month period. The paramedics more frequently were involved in ambulance collisions, suffered from stress, and were less likely to injure their back. There were minor interstate differences. Disability due to back injury affected 2.5% of those surveyed, four EMTs lost duty time secondary to an assault, and 0.5% of the EMTs were out of work due to stress. CONCLUSIONS: This survey begins to characterize the occupational risks of EMTs. The prevalence of back injuries, assault, stress, and extremity injuries seems to be too high. Educational programs and preventive interventions should be designed to minimize back injuries, stress, and assault. There is a need for more research nationwide in order to better characterize these injuries.     

Emergency Contraception Provision: A Survey of Emergency Department Practitioners

OBJECTIVES: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called "opt-out" or "abortion-related conscience clauses") with those of practitioners from states without these laws. METHODS: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed. RESULTS: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with "abortion-related conscience clauses" and those from other states. CONCLUSIONS: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. "Abortion-related conscience clauses" did not seem to influence willingness to offer EC.     

Emergency Department Visits for Injury in School-aged Children in the United States: A Comparison of Nonfatal Injuries Occurring Within and outside of the School Environment

Objectives: To compare the demographic and injury characteristics of children visiting the emergency department (ED) for nonfatal injuries occurring at school with those of same‐aged children who were injured outside of school. Methods: Data from a stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System (NEISS) were analyzed for 2001 and 2002. School and nonschool injury‐related ED visits were analyzed for patients who were 5 through 19 years of age. Results: There were an estimated 58,147,518 injury visits in all ages to the ED in 2001 and 2002. Injuries to school‐aged children (ages 5–19) accounted for an estimated 15,405,392 (26%) visits overall, of which 1,859,215 occurred at school (16.5% of visits by school‐aged children when location of injury was known). Males accounted for 63% of injuries at school; middle‐school children (ages 10–14 yr) accounted for a significantly greater proportion of injuries (46%) than did primary‐ (5–9 yr, 24%) or secondary‐school (15–19 yr, 30%) children (p < 0.001). In contrast, for injuries outside of school, secondary‐school children were injured most (40%), followed by middle‐ (32%) and primary‐aged children (27%). Nearly 11% of school injuries were classified as violent, whereas only 6.4% of the nonschool injuries in school‐aged children were violent (p < 0.001). Similarly, sports injuries were significantly more common at school (53% of injuries) than outside of school (32.9%; p < 0.001). Conclusions: A significant proportion of injuries to school‐aged children occur at school. Notable differences exist between the epidemiology of in‐ and out‐of‐school injuries. The nature of these injuries differs by age group. Efforts to reduce school injuries will require that these differences be examined further and incorporated into prevention initiatives.     

Screening Adolescents in the Emergency Department for Weapon Carriage

Objectives: The objective was to describe the prevalence and correlates of past‐year weapon involvement among adolescents seeking care in an inner‐city emergency department (ED). Methods: This cross‐sectional study administered a computerized survey to all eligible adolescents (age 14–18 years), 7 days a week, who were seeking care over an 18‐month period at an inner‐city Level 1 ED. Validated measures were administered, including measures of demographics, sexual activity, substance use, injury, violent behavior, weapon carriage, and/or weapon use. Zero‐inflated Poisson (ZIP) regression models were used to identify correlates of the occurrence and past‐year frequency of these weapons variables. Results: Adolescents (n = 2069, 86% response rate) completed the computerized survey. Fifty‐five percent were female; 56.5% were African American. In the past year, 20% of adolescents reported knife or razor carriage, 7% reported gun carriage, and 6% pulled a knife or gun on someone. Although gun carriage was more frequent among males, females were as likely to carry a knife or pull a weapon in the past year. Conclusions: One‐fifth of all adolescents seeking care in this inner‐city ED have carried a weapon. Understanding weapon carriage among teens seeking ED care is a critical first step to future ED‐based injury prevention initiatives. ACADEMIC EMERGENCY MEDICINE 2010; 17:168–176 © 2010 by the Society for Academic Emergency Medicine     

Emergency Department Characteristics of Male Sexual Assault

OBJECTIVE: To characterize the nature, frequency, and treatment of male sexual assault encountered by physicians in an ED. A minor objective compared the lengths of time the victim knew the assailant between males and females to determine whether there were differences between male and female victims. METHODS: Retrospective review over four years of all male patients with a diagnosis of sexual assault presenting to an urban academic ED in New York City. Demographics, types of injury, assailant/victim information, and treatment of the assault were obtained. RESULTS: Twenty-seven male sexual assaults (approximately 12% of all sexual assaults) were documented during this time period. Forcible rectal, oral, or both rectal and oral intercourse occurred 14, 4, and 9 times, respectively. Documented physical trauma occurred in nine of 27 visits, with two admissions for head trauma. Five additional patients complained of rectal pain with no independent objective evidence of trauma. Prophylactic treatment with antibiotics for the prevention of Neisseria gonorrhoeae and Chlamydia trachomatis was offered in 26 of 27 episodes and prophylactic HIV protection was given to only two of 21 eligible patients. Documentation of HIV status and HIV counseling occurred only in ten and five visits, respectively. The male-to-female odds ratios for whether the assailant was unknown, known less than 24 hours, or known more than 24 hours were 0.43 (95% CI = 0.15 to 1.26), 2.48 (95% CI = 0.94 to 6.53), and 0.92 (95% CI = 0.31 to 2.71), respectively. CONCLUSIONS: The percentage of total sexual assaults occurring in males who present to an ED is now more than 10% of all sexual assaults seen in this urban ED. These assaults are associated with a high proportion of patients with documented trauma. Although the treatment of traditional sexually transmitted diseases appears to be covered well, the need for HIV documentation, counseling, and possible HIV prophylaxis should be addressed more aggressively. In comparing the lengths of the relationships between the victim and the assailant, it appears twice as likely that the female victim will not know her assailant compared with the male, and twice as likely that the male victim will know his assailant less than 24 hours compared with the female.     

Validation study of injury surveillance data collected through Queensland hospital emergency departments

Objective : The objective of this study was to assess and validate the EDIS (Emergency Department Information System) as a means of acquiring Level 2 injury surveillance data as defined by the National Data Standards for Injury Surveillance in public hospital emergency departments in Queensland. Methods : This validation was based on interviews with patients presenting to selected emergency departments in Queensland for treatment of an injury which was then compared to data obtained from emergency department staff completing the routine medical record for these patients using EDIS. To assess the level of coding variability and set baseline levels of agreement the data were separately coded by three experienced coders and the level of agreement evaluated. At the time of the validation emergency department staff were also asked to complete a questionnaire relating to their attitudes towards EDIS and to injury surveillance. Results : A total of 572 cases of injury were collected during the period of the validation of which 509 (89.0%) corresponded to an injury recorded in EDIS. Demographic details collected in the emergency department data were coded correctly in almost all cases. The exception was Indigenous status where the emergency department systems recorded only 38% of the Indigenous cases correctly. Injury data fields were better than 85% complete for two sites but only 65% complete for the third. Coding agreement between Emergency Department Information System and the validation study for items relating to the injury event varied from 95% for Intent to 50% for Activity when injured. The interrater agreement analysis revealed that the highest agreement between the coders was for intent (94–96%) while the lowest was for main injury factor (63–78%). The results of the emergency department staff satisfaction survey showed a high acceptance of EDIS and injury surveillance in general. Conclusions : This analysis demonstrates that injury surveillance is a viable proposition for most emergency departments using computerized patient management systems designed with injury surveillance in mind. Emergency department‐based injury surveillance provides a pro‐active mechanism for monitoring injuries in specific areas of known concern, identifies previously unrecognized injury events and risk factors and permits the evaluation of preventive strategies.     

Violence to staff in a general hospital setting

The problem of aggression to staff in a general hospital was examined from the perspective of Poyner & Warne's (1986) model of workplace violence A total of 396 staff (39% response rate) provided information on their experience of violence in the past year and a subsample were additionally interviewed about their current levels of mental health (GHQ) Some 72 staff (21% of respondents) had been physically assaulted and 90% of these assaulted staff worked beyond the accident and emergency department, e g in medical wards Nurses were physically assaulted, threatened and verbally abused at higher rates than other professionals Employee factors (younger age, shorter National Health Service experience and attendance at violence training) were significantly associated with assault ( P < 0 05) Postoperative confusion, receiving treatment and delayed treatment were common precursors of aggression Mental health was significantly worse amongst staff exposed to threats (P < 0 01) This exploratory study establishes that violence is a problem across a number of general hospital departments and occupations and we argue that effective training should be made more available for staff at risk of assault     

Violence in society: fact or fiction?

Five hundred and twelve of the patients who presented to an inner city emergency department over a six month period with injuries sustained as a result of another's violence were studied. This demonstrated that the emergency department can play a significant role in the collection of data on violence. Until now Australian data on violence have come mainly from police files. However, 57% of the victims questioned in this study had not reported the attacks to the police. The data obtained have been analysed to provide information on recurring and preventable factors in the incidence of violence. A majority of victims had consumed drugs (54% alcohol, 5% other), and 33% of assailants were influenced by alcohol (39% unknown). Street violence was experienced in 78% of cases, but female victims were more likely to have been victims of violence in their own home, and usually knew the assailant. Only 9% of injuries were caused by a knife or other sharp instrument, the most common “weapon” was the assailant's fist. The usual site of injury was the head and neck (54%). Young single males were the most frequent victims.     

Acute Alcohol Use and Injury Patterns in Young Adult Prehospital Patients

The objective was to determine if acute alcohol consumption is associated with differences in injury pattern among young adult patients with traumatic injuries presenting to emergency medical services (EMS). A cross-sectional, retrospective review of prehospital patient care reports (PCRs) was conducted evaluating injured patients who presented to a collegiate EMS agency from January 1, 2011 to December 31, 2012. Included patients were age 18–24 y and sustained an injury within the previous 24 h. PCRs were reviewed independently by two abstractors to determine if the patient was documented to have acutely consumed alcohol proximate to his/her injury. Primary and secondary sites of regional body injury were recorded. Injury severity was recorded using the Revised Trauma Score (RTS). The association between primary injury site and acute alcohol use was assessed using a chi-square test. Multiple logistic regression was used to control for sex in predicting injury type. Of 440 injured patients, 135 (30.6%) had documented alcohol use prior to injury. Acute alcohol consumption altered the overall pattern of regional injury (p < 0.001). Alcohol users were more likely to present with injury secondary to assault, fall/trip, and unknown mechanism of injury (p < 0.001, all comparisons). RTS scores were statistically lower in the alcohol group (p < 0.001), although the clinical significance of this is unclear. Controlling for sex, acute alcohol consumption predicted increased risk of head/neck injury 5.59-fold (p < 0.001). Acute alcohol use in collegiate EMS patients appears to alter injury patterns in young adults and increases risk of head/neck injury. EMS providers in similar agencies should consider these trends when assessing and treating injured college-aged patients.     

Sexual assault in postmenopausal women: epidemiology and patterns of genital injury

Study objective

Physical abuse of older women, including reports of sexual assault, has risen rapidly for the last decade. The purpose of this study was to compare a group of postmenopausal victims of sexual assault with younger adult women (18-39 years old) by examining patient demographics, assault characteristics, and patterns of physical injury.

Methods

We conducted a retrospective cohort analysis to assess epidemiology and anogenital injuries in consecutive female victims presenting to sexual assault clinics and/or emergency departments within 3 counties of Western Michigan. All patients were examined by forensic nurses trained to perform medicolegal evaluations using colposcopy with nuclear staining. Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. Data from 2 patient groups (women aged 18-39 years vs postmenopausal women ≥50 years) were compared using χ² and t tests.

Results

During the 5-year study period, 1917 adult sexual assault victims met the inclusion criteria and comprised the study population as follows: 84% of the victims were 18 to 39 years old, and 4% were postmenopausal women at least 50 years old. The 72 postmenopausal victims were more likely to be assaulted by a single assailant, typically a stranger (56% vs 32%, P = .008), in their own home (74% vs 46%, P < .001) and experienced more physical coercion (72% vs 36%, P < .001). In comparison, the younger control group was more likely to have used alcohol or illicit drugs before the assault (53% vs 18%, P < .001) and have a history of sexual assault (51% vs 15%, P < .001). Postmenopausal victims had a greater mean number of nongenital (2.3 vs 1.2, P < .001) as well as anogenital injuries (2.5 vs 1.8, P < .001). The localized pattern and type of physical injuries were similar in both groups, although postmenopausal women tended to have more anogenital lacerations and abrasions.

Conclusion

The postmenopausal woman is not immune from sexual assault. The epidemiology of sexual trauma in this age group is uniquely different when compared to younger women, which may be useful in planning intervention and prevention strategies.     

Childhood Soccer Injuries Treated in U.S. Emergency Departments

Objectives: Soccer, an increasingly popular sport among children in the United States, is a common precipitant to injury‐related emergency department (ED) visits. The authors estimated the number of children treated in EDs for soccer‐related injuries and described the nature of these injuries. Methods: Data from the 2000 National Electronic Injury Surveillance System All Injury Program were used to estimate the overall number and rate of soccer injuries in children, calculate injury rates per 1,000 children, and describe the body regions affected and types of injuries. Results were stratified by five‐year age groups (5–9 years, 10–14 years, and 15–19 years). Results: Approximately 144,600 children sustained soccer‐related injuries in 2000 for a rate of 2.36 injuries per 1,000 children. Injury rates increased with age (0.8, 5–9 year olds; 3.1, 10–14 year olds; 3.2, 15–19 year olds). Common types of injuries were strains/sprains (36.7%), fractures (23.0%), and contusions (20.9%). Fractures decreased with age; sprains/strains increased with age. Commonly injured body regions varied by age. Wrist and finger injuries were most common (12.7% and 12.4%, respectively) in the youngest group; in the 10–14‐year‐old group, ankle and wrist injuries were most common (15.7% and 13.6%, respectively). In the oldest age group, ankle injuries were most common (21.9%), followed by knee injuries (17.6%). Conclusions: Substantial numbers of children were treated in EDs for soccer‐related injuries. Injury types and affected body regions varied by age. Injury prevention efforts to reduce soccer‐related injuries may need to be age specific.     

Factors affecting Israeli nurses' reports of violence perpetrated against them in the workplace: A test of the theory of planned behaviour

Ben Natan M, Hanukayev A, Fares S. International Journal of Nursing Practice 2011; 17 : 141–150 Factors affecting Israeli nurses' reports of violence perpetrated against them in the workplace: A test of the theory of planned behaviour Violence against nurses in the workplace is universal. Violence has negative implications for nurses, their patients and the medical facility. Nonetheless, violent incidents are only infrequently reported (20–25%). A correlational design was used to examine whether the guiding conceptual model, constructed of the variables: assailant traits, victim traits and type of violence, succeeds in predicting a nurse's decision to report violence perpetrated against them in the workplace. Data were gathered with a structured questionnaire, constructed specifically for the current research and based on the literature review and research model. The research population was sampled by convenience sampling and consisted of nurses from general hospitals in northern and central Israel of 220 nurses, of whom nearly 72% (n = 158) had experienced violent incidents over the past year, mainly verbal abuse by patients' relatives. Only 26.6% (n = 42) reported violent incidents in written form. Most reports were submitted to the nurse in charge of the department. Correlations were found between assailant traits (identity and mental state) and victim traits (sociodemographic characteristics and attitudes on and perceptions of reporting) and intention and actual report. Nurses' normative beliefs regarding reporting violence had the greatest effect on intention to report.     

Emt knowledge of ambulance traffic laws

Objective. The safe operation of ambulances using warning lights and siren requires both the public and emergency medical technician (EMT) drivers to understand and obey relevant traffic laws. However, EMTs may be unfamiliar with these laws. The purpose of this study was to evaluate EMTs' knowledge of traffic laws related to the operation of ambulances with warning lights and sirens. Methods. North Carolina EMTs participating in a statewide EMS conference October 6–8, 1995, completed a five-question survey. Knowledge of ambulance speed limits, yielding at intersections, yielding in roadways, and following distances was assessed using a multiple-choice format. Demographic data pertaining to EMT age, years of experience, paid vs volunteer status, driver's education courses, and past accident involvement were also obtained. Proportions were compared using chi-square analysis, alpha = 0.05. Results. Two-hundred ninety-three of 308 (95%) EMTs attending the conference completed questionnaires. The median number of correct responses to the five knowledge questions was 1 (range 0–4). Thirty-three percent of the EMTs knew that other vehicles are required by law to yield while either approaching or being overtaken by an ambulance with warning lights and sirens; 2% knew that due regard for safety is the only requirement of an ambulance approaching a red light at an intersection; 14% knew that the minimum following distance behind an ambulance is one city block; and 28% knew that there is no speed limit on ambulances with warning lights and sirens. Respondents were more likely to score above the median if they had taken one or more emergency driver's education courses or had nine years or more of EMS experience. Conclusion. In this sample, EMT knowledge of basic traffic laws pertaining to ambulance operation is poor. Emergency driver's education courses and increased experience appear to be related to increased knowledge scores. Increased training for EMTs about traffic laws may improve the safe operation of ambulances.     

HIV Postexposure Prophylaxis in Sexual Assault: Current Practice and Patient Adherence to Treatment Recommendations in a Large Urban Teaching Hospital

Background: Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations. Objectives: To determine factors associated with offering, following up with, and adhering to treatment when HIV nPEP is initiated for sexual assault victims. Methods: This was a retrospective chart review of female patients presenting with complaint of sexual assault to an urban ED from October 1, 1999, to September 30, 2002. HIV nPEP medications and/or follow‐up were provided without charge. Chi‐square analysis identified factors associated with being offered or referred for nPEP and follow‐up. Variables significant at the p < 0.10 level were entered into logistic regression analysis. Results: Two hundred twenty‐nine charts were reviewed. The final sample size was 181. Mean age was 29.1 years; median time from assault to presentation was 10.1 hours; 51.5% of the assailants were known to the victims. HIV nPEP was offered to 89 (49%) patients, and 11 patients were referred to an HIV nurse. Eighty‐five (85%) patients accepted, 38 of these 85 (45%) followed up, and 18 of the 85 (21%) completed treatment. In multivariate analysis, three variables were statistically significantly associated with increased likelihood of referral or being offered HIV nPEP: unknown assailant, having insurance, and younger age. Treatment was completed by 15 of 82 (18%) of ED‐initiated patients, versus three of three (100%) referred for initiation. The authors were unable to identify factors associated with completing treatment. Conclusions: HIV nPEP was offered to less than half of sexual assault patients, and few completed treatment. Further studies are needed to evaluate and improve appropriateness of HIV nPEP administration and follow‐up.