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Diagnostic accuracy in child sexual abuse medical evaluation: role of experience, training, and expert case review.
Child Abuse Negl 2012; 36(5):383-92CA

Abstract

OBJECTIVES

(1) The purpose of this study was to assess the ability of clinicians who examine children for suspected sexual abuse to recognize and interpret normal and abnormal ano-genital findings in magnified photographs using an online survey format. (2) Determine which factors in education, clinical practice, and case review correlate with correct responses to the survey questions.

METHODS

Between July and December 2007, medical professionals participated in a web-based survey. Participants answered questions regarding their professional background, education, clinical experience, and participation in case review. After viewing photographs and clinical information from 20 cases, participants answered 41 questions regarding diagnosis and medical knowledge. Answers chosen by an expert panel were used as the correct answers for the survey.

RESULTS

The mean number of correct answers among the 141 first-time survey respondents was 31.6 (SD 5.9, range 15-41). Child Abuse Pediatricians (CAP) had mean total scores which were significantly higher than Pediatricians (Ped) (34.8 vs. 30.1, p<0.05) and Sexual Assault Nurse Examiners (SANE) (34.8 vs. 29.3, p<0.05). The mean total scores for Ped, SANE, and Advanced Practice Nurses (APN) who examine fewer than 5 children monthly for possible CSA were all below 30. Total score was directly correlated with the number of examinations performed monthly (p=0.003). In multivariable regression analysis, higher total score was associated with self-identification as a CAP, reading The Quarterly Update newsletter (p<0.0001), and with quarterly or more frequent expert case reviews using photo-documentation (p=0.0008).

CONCLUSIONS

Child Abuse Pediatricians, examiners who perform many CSA examinations on a regular basis, examiners who regularly review cases with an expert, and examiners who keep up to date with current research have higher total scores in this survey, suggesting greater knowledge and competence in interpreting medical and laboratory findings in children with CSA. Review of cases with an expert in CSA medical evaluation and staying up to date with the CSA literature are encouraged for non-specialist clinicians who examine fewer than 5 children monthly for suspected sexual abuse.

Authors+Show Affiliations

University of California, San Diego School of Medicine, Rady Children's Hospital, San Diego, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22632855

Citation

Adams, Joyce A., et al. "Diagnostic Accuracy in Child Sexual Abuse Medical Evaluation: Role of Experience, Training, and Expert Case Review." Child Abuse & Neglect, vol. 36, no. 5, 2012, pp. 383-92.
Adams JA, Starling SP, Frasier LD, et al. Diagnostic accuracy in child sexual abuse medical evaluation: role of experience, training, and expert case review. Child Abuse Negl. 2012;36(5):383-92.
Adams, J. A., Starling, S. P., Frasier, L. D., Palusci, V. J., Shapiro, R. A., Finkel, M. A., & Botash, A. S. (2012). Diagnostic accuracy in child sexual abuse medical evaluation: role of experience, training, and expert case review. Child Abuse & Neglect, 36(5), pp. 383-92. doi:10.1016/j.chiabu.2012.01.004.
Adams JA, et al. Diagnostic Accuracy in Child Sexual Abuse Medical Evaluation: Role of Experience, Training, and Expert Case Review. Child Abuse Negl. 2012;36(5):383-92. PubMed PMID: 22632855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic accuracy in child sexual abuse medical evaluation: role of experience, training, and expert case review. AU - Adams,Joyce A, AU - Starling,Suzanne P, AU - Frasier,Lori D, AU - Palusci,Vincent J, AU - Shapiro,Robert Allan, AU - Finkel,Martin A, AU - Botash,Ann S, Y1 - 2012/05/25/ PY - 2011/04/23/received PY - 2011/12/26/revised PY - 2012/01/11/accepted PY - 2012/5/29/entrez PY - 2012/5/29/pubmed PY - 2012/8/29/medline SP - 383 EP - 92 JF - Child abuse & neglect JO - Child Abuse Negl VL - 36 IS - 5 N2 - OBJECTIVES: (1) The purpose of this study was to assess the ability of clinicians who examine children for suspected sexual abuse to recognize and interpret normal and abnormal ano-genital findings in magnified photographs using an online survey format. (2) Determine which factors in education, clinical practice, and case review correlate with correct responses to the survey questions. METHODS: Between July and December 2007, medical professionals participated in a web-based survey. Participants answered questions regarding their professional background, education, clinical experience, and participation in case review. After viewing photographs and clinical information from 20 cases, participants answered 41 questions regarding diagnosis and medical knowledge. Answers chosen by an expert panel were used as the correct answers for the survey. RESULTS: The mean number of correct answers among the 141 first-time survey respondents was 31.6 (SD 5.9, range 15-41). Child Abuse Pediatricians (CAP) had mean total scores which were significantly higher than Pediatricians (Ped) (34.8 vs. 30.1, p<0.05) and Sexual Assault Nurse Examiners (SANE) (34.8 vs. 29.3, p<0.05). The mean total scores for Ped, SANE, and Advanced Practice Nurses (APN) who examine fewer than 5 children monthly for possible CSA were all below 30. Total score was directly correlated with the number of examinations performed monthly (p=0.003). In multivariable regression analysis, higher total score was associated with self-identification as a CAP, reading The Quarterly Update newsletter (p<0.0001), and with quarterly or more frequent expert case reviews using photo-documentation (p=0.0008). CONCLUSIONS: Child Abuse Pediatricians, examiners who perform many CSA examinations on a regular basis, examiners who regularly review cases with an expert, and examiners who keep up to date with current research have higher total scores in this survey, suggesting greater knowledge and competence in interpreting medical and laboratory findings in children with CSA. Review of cases with an expert in CSA medical evaluation and staying up to date with the CSA literature are encouraged for non-specialist clinicians who examine fewer than 5 children monthly for suspected sexual abuse. SN - 1873-7757 UR - https://www.unboundmedicine.com/medline/citation/22632855/Diagnostic_accuracy_in_child_sexual_abuse_medical_evaluation:_role_of_experience_training_and_expert_case_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0145-2134(12)00080-4 DB - PRIME DP - Unbound Medicine ER -