Palusci Vincent J, Cox Edward O, Shatz Eugene M, Schultze Joel M
Child Protection Center, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Ste. 1K40, Detroit, MI 48201, USA.
Child Abuse Negl. 2006 Apr;30(4):367-80. doi: 10.1016/j.chiabu.2005.11.002.
Immediate medical assessment has been recommended for children after sexual abuse to identify physical injuries, secure forensic evidence, and provide for the safety of the child. However, it is unclear whether young children seen urgently within 72 hours of reported sexual contact would have higher frequencies of interview or examination findings as compared to those seen non-urgently or whether forensic findings would be affected by child characteristics, type of reported contact, or later events.
DESIGN/SETTING: We evaluated 190 consecutive cases of children under 13 years of age urgently referred during a 5-year period in 1998-2003 to a community child advocacy center and compared them to those non-urgently referred with regard to their physical examination findings, any sexually transmitted infections or forensic evidence, gender, pubertal development, type of contact, reported ejaculation, later bathing or changing clothes, time to examination, and gender, age and relationship of alleged perpetrator.
Children seen urgently were younger and had less frequent CPS involvement, more disclosures, and more positive physical examinations, and had more contact with older perpetrators than those seen non-urgently. Overall, most children were female and had normal or non-specific physical examinations. Certain case characteristics were predictive of evidence isolation in the 9% who had positive forensic evidence identified. Semen or sperm was identified from body swabs only from non-bathed, female children older than 10 years of age or on clothing or objects.
Female children over 10 years old who report ejaculation or genital contact without bathing have the highest likelihood of positive examinations or forensic evidence. While there are other potential benefits of early examination, physicians seeking to identify forensic evidence should consider the needs of the child and other factors when determining the timing of medical assessment after sexual abuse.
对于遭受性虐待的儿童，建议进行即时医学评估，以确定身体损伤情况、获取法医证据并保障儿童安全。然而，尚不清楚在报告性接触后72小时内紧急就诊的幼儿与非紧急就诊的幼儿相比，面谈或检查结果的发生率是否更高，或者法医检查结果是否会受到儿童特征、报告的接触类型或后续事件的影响。
设计/地点：我们评估了1998年至2003年的5年期间连续紧急转诊至社区儿童权益保护中心的190例13岁以下儿童的病例，并将他们与非紧急转诊的儿童在体格检查结果、任何性传播感染或法医证据、性别、青春期发育、接触类型、报告的射精情况、后续洗澡或更换衣服情况、检查时间以及被指控犯罪者的性别、年龄和关系等方面进行了比较。
与非紧急就诊的儿童相比，紧急就诊的儿童年龄更小，儿童保护服务机构（CPS）介入的频率更低，披露情况更多，体格检查阳性结果更多，并且与年龄较大的犯罪者接触更多。总体而言，大多数儿童为女性，体格检查结果正常或不具有特异性。在9%有阳性法医证据的儿童中，某些病例特征可预测证据的分离情况。仅在未洗澡的10岁以上女童的身体拭子、衣物或物品上发现了精液或精子。
报告射精或生殖器接触后未洗澡的10岁以上女童进行阳性检查或获得法医证据的可能性最高。虽然早期检查还有其他潜在益处，但寻求确定法医证据的医生在确定性虐待后医学评估的时间时，应考虑儿童的需求和其他因素。
