Physicians' documentation of sexual abuse of children
R. R. Socolar, M. Champion and C. Green
Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, USA.
OBJECTIVES: To assess the quality of documentation by physicians in their
evaluations for sexual abuse of children and to define factors that affect
documentation. DESIGN: Cross-sectional survey and blinded chart review.
SETTING: A statewide program for child abuse evaluations. PARTICIPANTS:
Physicians (n = 145) who performed evaluations during fiscal year 1992-1993
were surveyed. Up to five randomly chosen medical records (n = 548),
obtained from each eligible physician, were reviewed. INTERVENTIONS: None.
MEASUREMENTS AND RESULTS: A survey of physicians who participated in the
statewide program was made in summer 1993, with 78% participation.
Knowledge scores were derived from the survey based on a comparison with
the responses of a panel of five experts. Charts that were obtained from
eligible physicians were assessed by two blinded reviewers. Documentation
of the history and physical examination was evaluated as good or excellent
by 30% and 23% of the physicians, respectively. Factors that were
positively associated with better documentation of the history included a
more structured format for the record, continuing medical education courses
on sexual abuse of children, female gender, and a history of disclosure (P
< .005 for all). Factors that were related to good documentation of the
physical examination included structured records, continuing medical
education courses, female gender, and knowledge scores. Factors that were
not related to knowledge or documentation included the number of
evaluations performed, practice group size or location, age of the
physician, and a physician's reading of journal articles about sexual abuse
of children. CONCLUSION: Quality of evaluations for sexual abuse of
children may be improved by the use of structured records and participation
in continuing medical education courses with regard to sexual abuse of
children.
