title: Value of follow-up examinations of children and adolescents evaluated for sexual abuse and assault.
abstract: OBJECTIVE
  The purpose of this study was to determine whether follow-up examinations of suspected victims of child sexual abuse influence medical diagnosis or treatment.
  
  
  METHODS
  A retrospective chart review of patients with initial and follow-up examinations (examinations 1 and 2, respectively) over a 5-year study period was conducted. Patient and abuse characteristics, interval between examinations and abuse, and examiner experience levels were collected; examination findings and test results for sexually transmitted infections (STIs) were compared for examinations 1 and 2.
  
  
  RESULTS
  Among 727 patients, examination 2 resulted in a change in interpretation of trauma likelihood in 129 (17.7%) patients and identified STIs in 47 (6.5%) patients. Changes in trauma likelihood and detection of additional STIs during follow-up examinations were more likely in adolescent, female, and sexually active patients and those with a history of genital-genital contact, unknown examination 1 findings, or drug-facilitated sexual assault. Although examination 2 was less likely to affect the interpretation of trauma likelihood and STIs in preadolescent patients, a change in interpretation of trauma likelihood was noted for 49 (15.5%) of these patients, and 16 (5.1%) were diagnosed with a new STI on examination 2. The level of clinician experience during examination 1 did affect the likelihood of changes in examination findings during examination 2.
  
  
  CONCLUSIONS
  Follow-up examinations by specialists affected the interpretation of trauma and detection of STIs in ∼23% of pediatric patients undergoing sexual abuse assessments.
authors.affiliation: Division of Child Abuse and Neglect, Department of Pediatrics, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA. amy.r.gavril.mil@health.mil
authors.forename: Amy R
authors.initials: AR
authors.lastname: Gavril
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Kellogg
authors.forename: Prakash
authors.initials: P
authors.lastname: Nair
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000706:statistics & numerical data / Q000628:therapy; D005260:Female; D005836:Genitalia, Female / Q000293:injuries; D005837:Genitalia, Male / Q000293:injuries; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D010808:Physical Examination; D019233:Retreatment; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology; D013781:Texas; D014754:Violence / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000628:therapy