title: Genital examinations for alleged sexual abuse of prepubertal girls: findings by pediatric emergency medicine physicians compared with child abuse trained physicians.
abstract: OBJECTIVE
  This study compares abnormal genital examination findings made by pediatric emergency medicine (PEM) physicians to examinations by physicians with training in child sexual abuse in the evaluation of prepubertal girls for suspected sexual abuse.
  
  
  METHODS
  A prospective study was performed following the genital examination by a PEM physician of prepubertal girls suspected of being sexually abused. A physician with training in child sexual abuse re-examined those girls whose examinations were interpreted as abnormal by the PEM physicians. The findings and interpretations of the PEM physician were then compared to those by the physicians with training in child abuse.
  
  
  RESULTS
  Between October 1994 and October 1998, 46 patients diagnosed by PEM physicians with nonacute genital findings indicative of sexual abuse were re-examined by a physician with training in child abuse. The follow-up examinations were done 2 days-16 weeks (mean 2.1 weeks) after the emergency department visit. The physicians with training in child abuse concluded that only eight of these children (17%) showed clear evidence of abuse. Normal findings were noted in 32 children (70%), nonspecific changes were noted in 4 children (9%), and 2 children (4%) had findings that are more commonly seen in abused children than nonabused children but are not diagnostic for abuse (concerning for abuse).
  
  
  CONCLUSIONS
  There was poor agreement between the pediatric emergency medicine physicians and the physicians with training in child sexual abuse. This study suggests that emergency medicine physicians should consider additional training in this area. In addition, all children with abnormal ED examinations should have follow-up examinations by a child abuse trained physician.
authors.affiliation: Division of Emergency Medicine and Mayerson Center for Safe and Healthy Children, Children's Hospital Medical Center, SEB-5, Burnet Avenue, Cincinnati, OH 3333, USA.
authors.forename: Kathi L
authors.initials: KL
authors.lastname: Makoroff
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Brauley
authors.forename: Ann M
authors.initials: AM
authors.lastname: Brandner
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Myers
authors.forename: Robert A
authors.initials: RA
authors.lastname: Shapiro
mesh_terms: D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D002983:Clinical Competence; D004635:Emergency Medicine / Q000193:education / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005836:Genitalia, Female / Q000293:injuries / Q000473:pathology*; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007223:Infant; D009820:Ohio; D010372:Pediatrics / Q000193:education / Q000592:standards*; D010808:Physical Examination / Q000592:standards*; D011446:Prospective Studies; D019522:Vaginal Discharge