Children referred for possible sexual abuse: medical findings in 2384 children
Children referred for possible sexual abuse: medical findings in 2384 children
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DOI：
10.1016/s0145-2134(02)00339-3
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发表时间：
2002-06-01
影响因子：
4.8
通讯作者：
Bernier, R
中科院分区：
文献类型：
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作者：
Heger, A;Ticson, L;Bernier, R
目的：本研究的目的是比较2384名儿童的5年前瞻性研究中的阳性医学发现率，这些儿童被转诊用于评估可能的性虐待，并进行了20年的研究。前瞻性研究总结了人口统计学信息，临床病史，肇事者的关系，虐待的性质和临床结果。该研究报告的结果由模式的转介和医疗examination.Results：有2384名儿童在三级转诊中心1985年和1990年之间进行评估，可能的性虐待。儿童在披露性虐待后被转介，因为行为改变或暴露于虐待环境，以及可能的医疗条件。在所有接受评估的儿童中，共有96.3%的儿童进行了正常的体检; 95.6%的报告虐待的儿童是正常的，99.8%的因行为改变或暴露于虐待而被转介的儿童也是正常的。在182名转诊接受医疗状况评估的儿童中，92%的儿童在儿童倡导中心检查时被发现是正常的。其余15/182例（8%）被发现异常，被诊断患有性传播疾病、急性或愈合的生殖器损伤，占被发现有虐待医学诊断的病例总数的17%（15/88）。对儿童的访谈表明，68%的女孩和70%的男孩报告了严重的虐待，定义为插入阴道或肛门。与1%的男孩相比，女孩（6%）的插入与更高比例的异常结果相关。施虐者的关系影响的严重程度abuse.Conclusion：研究表明，医疗，社会和法律的专业人士过于依赖的医疗检查诊断儿童性虐待。儿童的历史仍然是得出儿童遭受性虐待的结论的唯一最重要的诊断特征。在接受性虐待医疗评估的所有儿童中，只有4%在评估时检查结果异常。即使有严重的虐待史，如阴道或肛门渗透，异常医学发现的比率也只有5.5%。亲生父母比替代父母、大家庭成员或陌生人更不可能进行严重虐待。(C)2002爱思唯尔科技有限公司。保留所有权利。
Objective: The goal of this study was to compare rates of positive medical findings in a 5-year prospective study of 2384 children, referred for evaluation of possible sexual abuse, with two decades of research. The prospective study summarizes demographic information, clinical history, relationship of perpetrators, nature of abuse, and clinical findings. The study reports on the results by patterns of referral and the medical examination.Results: There were 2384 children evaluated in a tertiary referral center between 1985 and 1990 for possible sexual abuse. Children were referred after they disclosed sexual abuse, because of behavioral changes or exposure to an abusive environment, and because of possible medical conditions. A total of 96.3% of all children referred for evaluation had a normal medical examination; 95.6% of children reporting abuse were normal, 99.8% who were referred for behavioral changes or exposure to abuse were also normal. Of the 182 children referred for evaluation of medical conditions, 92% were found to be normal at the time,of examination by-the Child Advocacy Center. The remaining 15/182 (8%) that were found to be abnormal were diagnosed with sexually transmitted diseases, acute or healed genital injuries, and were 17% (15/88) of the total cases found to have medical findings diagnostic of abuse. Interviews of the children indicated that 68% of the girls and 70% of the boys reported severe abuse, defined as penetration of vagina or anus. Penetration was associated with a higher percentage of abnormal findings in girls (6%) compared to 1% of the boys. The relationship of the abuser impacted on the severity of the abuse.Conclusion: Research indicates that medical, social, and legal professionals have relied too heavily on the medical examination in diagnosing child sexual abuse. History from the child remains the single most important diagnostic feature in coming to the conclusion that a child has been sexually abused., Only 4% of all children referred for medical evaluation of sexual abuse have abnormal examinations at the time of evaluation. Even with a history of severe abuse such as vaginal or anal penetration, the rate of abnormal medical findings is only 5.5%. Biological parents are less likely to engage in severe abuse than parental substitutes, extended family members, or strangers. (C) 2002 Elsevier Science Ltd. All rights reserved.