Predictors of diagnostic findings in child/adolescent sexual abuse exams

OBJECTIVE: To determine the predictors of physical examination findings which are diagnostic of trauma -Anogenital examinations in children and adolescents with concerns of sexual abuse are frequently normal or nonspecific.... [ view full abstract ]

OBJECTIVE: To determine the predictors of physical examination findings which are diagnostic of trauma -Anogenital examinations in children and adolescents with concerns of sexual abuse are frequently normal or nonspecific. Predictive factors for abnormal examination findings are important in determining optimal timing of examination, and have not been systematically examined to date-and/or sexual contact in a large sample of children and adolescents seen at a hospital based sexual abuse center.
METHODS: Medical charts of children aged 0-18 years evaluated for sexual abuse/assault between 1995-2008 were reviewed. Case details and ano-genital examination findings were extracted. Ano-genital examination findings, as documented in the patient’s health record, were classified according to a recently-published consensus approach to interpreting medical findings in suspected child sexual abuse (Adams, 2007). Analyses were conducted using logistic regression.
RESULTS: 3569 patients examined for sexual abuse concerns were identified. Diagnostic findings were documented in 173 (4.9% of the sample) of the study group. Age was significantly associated with diagnostic finding: adolescents (>12) had a diagnostic rate of 13.9% whereas children (<12) had a diagnostic rate of 2.2%. As a result, subsequent analyses for children and youth were conducted separately. Predictors of diagnostic findings for adolescents were unknown versus known perpetrator, report of vaginal versus no vaginal penetration, and documented versus no documented symptoms. Predictors of diagnostic findings for children were seen within 72 versus more than 72 hours of the assault, unknown versus known perpetrator, reported vaginal versus no vagina penetration, and documented versus no documented symptoms. CONCLUSIONS: This study confirms the low overall rate (4.9%) of diagnostic findings, and points to systematic differences in diagnostic rates between children and adolescents. The identified factors associated with diagnostic findings will assist clinicians in triaging cases by predicting those that may be most likely to have documented examination findings.