title: Child sexual abuse--Medical statement conclusions in criminal legal process.
abstract: OBJECTIVE
  To evaluate medical statement conclusions in the criminal-legal process in suspected cases of child sexual abuse (CSA).
  
  
  METHODS
  An observational study of a random sample of 130 medically examined, police reported CSA suspected cases during 2001-2009. Medical statements were evaluated and their conclusions were analyzed with an end-point in the legal process. The data consists of official investigation documents from the University Hospital records, the Police, crime laboratories, the State Prosecutor, and the Courts of Law.
  
  
  RESULTS
  The median age of the children was 5.3 years (range 11 months-17.3 years) at the time of the suspected sexual abuse. In most cases (76.2%, 99/130) medical statement conclusions neither supported nor excluded the suspicion of CSA. Twenty-one (16.2%) medical statements supported and in 10 cases (7.7%) the conclusion did not support the suspected CSA. Of the suspected CSA cases a hundred (76.9%) proceeded to the Prosecutor. The charge filing rate was 41.5% (54/130). The final conviction rate was 30.8% (40/130) and 74% in the charged cases. Medical statements were mentioned as evidence in the Prosecutor's decision to file charges in 18 (33.3%) of suspected CSA cases and in 15 (36%) of verdicts. A child's clear disclosure of CSA (p<0.001) and medical statements (p=0.037) had a significant role in decision making on convictions.
  
  
  CONCLUSIONS
  In medical statement conclusions, physical findings with proper documentation and interpretation are needed to avoid misunderstandings in the legal process. The present study supports a routine medical statement peer review to minimize the risk of neglect caused by lack of knowledge among authorities working with sexually abused children.
authors.affiliation: Departments of Gynecology and Obstetrics and Child Psychiatry, Tampere University Hospital, Tampere, Finland. Electronic address: minna.joki-erkkila@pshp.fi.
authors.forename: Minna
authors.initials: M
authors.lastname: Joki-Erkkilä
authors.affiliation: Research Unit, Police College of Finland, Tampere, Finland.
authors.forename: Jenni
authors.initials: J
authors.lastname: Niemi
authors.affiliation: Research Unit, Police College of Finland, Tampere, Finland.
authors.forename: Noora
authors.initials: N
authors.lastname: Ellonen
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000331:legislation & jurisprudence*; D002675:Child, Preschool; D004247:DNA / Q000302:isolation & purification; D016172:DNA Fingerprinting; D004282:Documentation; D005260:Female; D005387:Finland; D005554:Forensic Medicine / Q000331:legislation & jurisprudence*; D006801:Humans; D007223:Infant; D008297:Male; D010808:Physical Examination; D012189:Retrospective Studies; D012661:Semen
chemical_list: D004247:DNA
keywords: Child sexual abuse; Legal outcome; Medical statement; Medico-legal report; Physical findings