Most sexually abused children will not have signs of genital or anal injury, especially when examined nonacutely. A recent study reported that only 2.2% (26 of 1160) of sexually abused girls examined nonacutely had diagnostic physical findings, whereas among those examined acutely, the prevalence of injuries was 21.4% (73 of 340). It is important for health care professionals who examine children who might have been sexually abused to be able to recognize and interpret any physical signs or laboratory results that might be found. In this review we summarize new data and recommendations concerning documentation of medical examinations, testing for sexually transmitted infections, interpretation of lesions caused by human papillomavirus and herpes simplex virus in children, and interpretation of physical examination findings. Updates to a table listing an approach to the interpretation of medical findings is presented, and reasons for changes are discussed.
The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice guidelines in this field. Since 2007, when the article was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse. A group of specialists in child abuse pediatrics met in person and via online communication from 2011 through 2014 to review published research as well as recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics and to reach consensus on if and how the guidelines and approach to interpretation table should be updated. The revisions are based, when possible, on data from well-designed, unbiased studies published in high-ranking, peer-reviewed, scientific journals that were reviewed and vetted by the authors. When such studies were not available, recommendations were based on expert consensus.
The emergency department (ED) is a vital entry point in the health care system for children who experience maltreatment. This study fills a gap in the maltreatment literature by presenting systematic, national estimates of maltreatment-related ED visits in the United States by children ≤3 years old, from 2006 to 2011, using the Nationwide Emergency Department Sample (NEDS). Children who experienced and likely experienced maltreatment were identified via International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Maltreatment was classified as physical or sexual abuse, neglect, or poly-victimization. The clinical and demographic profiles of children who experienced maltreatment were described. Approximately 10,095 children who experienced maltreatment (0.1% of total ED visits) and 129,807 children who likely experienced maltreatment (1.2% of total ED visits) were documented each year. Maltreatment was associated with significantly greater risk of injury, hospitalization, and death in the ED setting. Physical abuse was the most common explicit maltreatment diagnosis (33 ED visits per 100,000 children ≤3 years old) and neglect was the most common likely maltreatment diagnosis (436 ED visits per 100,000 children ≤3 years old). This study established the NEDS as a valuable complement to existing surveillance efforts of child maltreatment from a public health perspective.
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