254 THE MEDICAL NECESSITY OF PEDIATRIC SEXUAL ASSAULT EVALUATIONS. (1st January 2005) - Giacobbe, L.
Abstract : Purpose: Children who are alleged victims of sexual assault are often referred for medical evaluation by parties whose primary interest is the collection and documentation of forensic evidence. The objective of this study was to determine, for a population of children who underwent a medical examination following alleged sexual assault, the proportion for whom an important medical and/or psychological diagnosis was made during the evaluation. Methods: Medical records of children who presented to a child advocacy center for a sexual assault examination from December 1, 2003 through April 30, 2004 were reviewed for forensic findings and medical and psychological diagnoses. Only diagnoses that were judged by the physician to require intervention at the time of the evaluation were considered. Results: 473 children (81% girls) presented to the advocacy center for a sexual assault examination during the study period. Of these, 9 refused or deferred all or part of the medical examination. A medical or psychological diagnosis that required intervention by the examiner was made for 123 children (26%). Of these, 39 diagnoses (representing 8% of the total study population) had the potential to result in significant patient morbidity if not immediately addressed. In contrast, 44 children (9%) had "probable" or "definite" physical or laboratory evidence that supported the allegation of sexual assault. Conclusions: In our population, the number of children who had a medical and/or psychological diagnosis was significantly higher than the number of children with probable or definite evidence of penetrating anogenital trauma or sexual contact. The number of children with diagnoses that could have resulted in significant morbidity was nearly the same as the number with evidence of sexual assault. Implications: In many busy medical settings, following a screening examination by a physician, the collection of forensic evidence from sexual assault victims is performed by providers who are not licensed to diagnose and treat medical conditions. Our results demonstrate the importance of careful physician oversight of sexual assault evaluations.