Emergency Severity Index (ESI) Triage for Sexual Assault Patients

Rationale for ESI Level 2 Assignment

• The Emergency Nurses Association and American College of Emergency Physicians recommend a 5-level Emergency Severity Index as the preferred system for triage in a busy ED, with sexual assault patients placed in the level 2 or "needs immediate assessment" category, the same as for an unstable trauma patient or a critical care cardiac patient 1
• ESI Level 2 is appropriate because sexual assault is considered a high-risk situation requiring prompt medical and forensic attention, even when the patient appears stable with no visible injuries 1

Clinical Assessment Considerations

• While the patient has stable vital signs and no visible injuries, sexual assault victims may have non-visible injuries or psychological trauma requiring prompt intervention 2

Time-Sensitive Aspects of Care

• The ESI Level 2 designation ensures that sexual assault patients receive timely care, which is critical for timely administration of emergency contraception, which is most effective when given as soon as possible 2
• The ESI Level 2 designation ensures that sexual assault patients receive timely care, which is critical for prompt prophylaxis against sexually transmitted infections 2

Common Pitfalls to Avoid

• Avoid being influenced by the absence of visible injuries or stable vital signs, as these do not diminish the urgency of care needed for sexual assault victims 1, 2

Special Considerations

• Sexual assault patients require a private, safe environment for examination and interview, which should be facilitated promptly 2
• The psychological impact of sexual assault requires immediate attention, even when physical injuries are not apparent 2
• Documentation of the time of assault is critical for both medical and legal purposes, as it affects decisions about prophylactic treatments and evidence collection 2