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Acad Emerg Med. 2018 Oct 31. doi: 10.1111/acem.13497. [Epub ahead of print]

Evaluation of a Screening Tool for Child Sex Trafficking Among Patients With High-Risk Chief Complaints in a Pediatric Emergency Department.

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Emory School of Medicine, Atlanta, GA.
Children's Healthcare of Atlanta, Atlanta, GA.
Departments of Pediatrics and Emergency Medicine, Emory School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA.
Department of Pediatrics, Atlanta, GA.
Department of Emergency Medicine, Atlanta, GA.



The objective was to apply and evaluate a screening tool to identify victims of child sex trafficking (CST) in a pediatric emergency department (PED) population.


This prospective, observational study was conducted from July 2017 to November 2017 at the PED of a free-standing, inner-city children's hospital. Patients 10 to 18 years of age presenting with chief complaints related to high-risk social or sexual behaviors were recruited in a representative convenience sampling. A previously developed six-item screening tool was administered verbally to participants. A positive screen was defined as two positive answers from the six items. A patient was considered a "true" CST victim if any information obtained during the visit indicated that their circumstances fulfilled the federal definition of CST. Descriptive statistics were calculated for all variables of interest. CST screening tool analysis included sensitivity, specificity, and positive and negative predictive values (PPV, NPV). Those patients identified as positive for CST were referred to social services and received the current standard of care.


A total of 254 patients met chief complaint screening criteria and eligibility; 215 were approached to participate and 203 agreed to participate. Of the 203 participants, 100 screened positive with the tool (49%). The total number of CST victims identified was 11 (5.4%), 10 of whom screened positive. With a cutoff score of two positive answers the tool demonstrated a 90.9% (95% confidence interval [CI] = 58.7%-99.8%) sensitivity, 53.1% (95% CI = 45.6%-60.4%) specificity, 10.0% (95% CI = 5.0%-17.6%) PPV, and 99.0% (95% CI = 94.7%-99.9%) NPV.


Applied to an inner-city PED population of 203 participants with high-risk chief complaints, the screening tool has high sensitivity and high NPV. This makes it appropriate for an initial screening to rule out CST in this high-risk population. Applicability for broader use and additional practice settings are warranted given the significant positivity rate among those presenting with high-risk concerns.


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