Proportion of diagnostic findings in 3569 cases of suspected child sexual abuse

Background and Objectives: Accurate interpretation of ano-genital examination findings in the context of suspected child sexual abuse is essential as misinterpretation may have significant child protection and criminal justice... [ view full abstract ]

Background and Objectives:
Accurate interpretation of ano-genital examination findings in the context of suspected child sexual abuse is essential as misinterpretation may have significant child protection and criminal justice implications. A systematic approach to interpretation of ano-genital examination findings, based upon regularly updated evidence and expert consensus, is now widely utilized to support accurate diagnosis (Adams, 2007). We hypothesized that applying this approach, the rate of diagnostic findings is lower than previously published in a large sample of children and adolescents. The objective of this study was to determine the proportion of ano-genital examination findings that is diagnostic for trauma and/or sexual contact among children and adolescents evaluated for suspected sexual abuse.

Methods
Medical charts of children and adolescents aged 0-18 years evaluated for sexual abuse/assault between 1995 and 2008 were reviewed. Case details and ano-genital examination findings were extracted and interpreted using a current, published consensus approach. The proportion of diagnostic findings was estimated.

Results
3569 patients were included in this study. Ano-genital examination findings diagnostic of trauma and/or sexual contact were present in 173 (4.9%) of the study group. The rate of diagnostic findings was 13.9% in adolescents and 2.2% in children.

Conclusions
This study confirms the low overall percentage (4.9%) of diagnostic findings found among children referred for suspected sexual abuse with markedly different estimates among adolescents as compared to children. Despite changes and adaptations in diagnostic classification systems, as well as evolving medical knowledge and research in the area of child sexual abuse, the prevalence of diagnostic findings is consistent with previous studies.