Assessments of girl's genital findings and the likelihood of sexual abuse: agreement among physicians self-rated as skilled
J. E. Paradise, M. A. Finkel, A. S. Beiser, A. B. Berenson, D. B. Greenberg and M. R. Winter
Department of Pediatrics, Boston University School of Medicine, Mass, USA.
OBJECTIVES: To measure agreement about genital examination findings among
physicians who rate themselves as skilled in evaluating children for
suspected sexual abuse, to compare these physicians' descriptions and
interpretations with consensus standards developed by an expert panel, and
to investigate the effects of physician and case characteristics on
agreement. STUDY DESIGN: Questionnaires including 7 simulated cases, each
consisting of a brief history and 1 photograph of a girl's genitalia, were
mailed to random samples of 2 groups: the members of 4 physician
organizations concerned with child abuse or pediatric gynecology, and
pediatricians at large. Among the surveyed physicians who rated their own
skill in evaluating cases of suspected sexual abuse as higher than average,
we measured agreement, both overall and between those with the most and
with less clinical experience, and assessed their conformity with consensus
standard descriptions and interpretations. RESULTS: We received responses
from 548 (50.9%) of 1076 physicians; 414 responses (75.5%) were analyzable.
Two hundred six physicians (50%) rated themselves as skilled in assessing
children for sexual abuse. On average, 45% of these physicians'
descriptions and 72.6% of their interpretations conformed with the
consensus standards. In 4 cases, between 5% and 20.7% of these physicians
described genital findings that the expert panel had considered absent from
the photographs. Conformity with standard interpretations tended to be
higher in cases with photographs concordant with the accompanying,
unambiguous histories (P=.06). The most experienced physicians resembled
the expert panel more closely than did the less experienced self-rated
skilled physicians in interpreting 3 simulated cases (P< or =.001).
CONCLUSIONS: Assessments of girls' genital findings by physicians who rate
themselves as skilled in examining children for suspected sexual abuse
often differ. In some cases, among physicians who all rate themselves as
skilled, assessments made by very experienced physicians may conform more
closely to consensus standards than do assessments made by less experienced
physicians.
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Pediatrics 1999;104:178-178.
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Influence of the History on Physicians' Interpretations of Girls' Genital Findings
Paradise et al.
Pediatrics 1999;103:980-986.
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