Drocton Peter, Sachs Carolyn, Chu Lawrence, Wheeler Malinda
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Acad Emerg Med. 2008 Mar;15(3):231-8. doi: 10.1111/j.1553-2712.2008.00050.x.
Forensic investigators remain unsure exactly why some sexual assault victims display acute injury while others do not. This investigation explores potential reasons for these differential findings among female victims.
This cross-sectional analysis examined data from consecutive female sexual assault victims, at least 12 years old, who agreed to a forensic exam between November 1, 2002, and November 30, 2006. Exams utilized colposcopy, anoscopy, macrodigital imaging, and toluidine blue dye to delineate anogenital injury (AGI), which was defined as the presence of recorded anogenital abrasions, tears, or ecchymosis. Demographic variables of the victim, including sexual experience and reproductive parity, and assault characteristics were recorded in the database for bivariate and multivariate analysis with AGI.
Forty-nine percent of the initial 3,356 patients displayed AGI. Of this total, 2,879 cases included complete data for all variables and were included in the multivariate logistic regression model. A statistically significant increased risk for AGI was noted with: educational status (odds ratio [OR] 1.53, 95% CI = 1.25 to 1.87); vaginal or attempted penetration using penis (OR 2.29, 95% CI = 1.74 to 3.01), finger (OR 1.61, 95% CI = 1.88 to 1.94), or object (OR 3.19, 95% CI = 1.52 to 6.68); anal-penile penetration (OR 2.00, 95% CI = 1.57 to 2.54); alcohol involvement (OR 1.25, 95% CI = 1.04 to 1.50); and virgin status of victim (OR 1.38, 95% CI = 1.11 to 1.71). Victims were less likely to display AGI with a longer postcoital interval (OR 0.50, 95% CI = 0.39 to 0.65) and increased parity (OR 0.76, 95% CI = 0.57 to 0.99).
Approximately half the patients displayed AGI. This rate is higher than earlier studies, but consistent with current investigations utilizing similar injury detection methods. The correlates of injury found reinforce the findings of prior studies, while prompting questions for future study.
法医调查人员仍不确定为何有些性侵犯受害者会出现急性损伤，而另一些则不会。本研究探讨女性受害者中这些差异结果的潜在原因。
这项横断面分析研究了2002年11月1日至2006年11月30日期间同意接受法医检查的连续女性性侵犯受害者的数据，这些受害者年龄至少12岁。检查采用阴道镜检查、肛门镜检查、宏观数字成像和甲苯胺蓝染色来确定肛门生殖器损伤（AGI），AGI定义为记录到的肛门生殖器擦伤、撕裂或瘀斑。受害者的人口统计学变量，包括性经历和生育史，以及性侵特征都记录在数据库中，用于与AGI进行双变量和多变量分析。
最初的3356名患者中有49%出现了AGI。其中，2879例包含所有变量的完整数据，并被纳入多变量逻辑回归模型。发现以下因素会使AGI风险显著增加：教育程度（优势比[OR]1.53，95%置信区间=1.25至1.87）；使用阴茎（OR 2.29，95%置信区间=1.74至3.01）、手指（OR 1.61，95%置信区间=1.88至1.94）或物体进行阴道插入或尝试插入（OR 3.19，95%置信区间=1.52至6.68）；肛门阴茎插入（OR 2.00，95%置信区间=1.57至2.54）；涉及酒精（OR 1.25，95%置信区间=1.04至1.50）；以及受害者的处女身份（OR 1.38，95%置信区间=1.11至1.71）。性交后间隔时间较长（OR 0.50，95%置信区间=0.39至0.65）和生育史增加（OR 0.76，95%置信区间=0.57至0.99）的受害者出现AGI的可能性较小。
约一半的患者出现了AGI。这一比例高于早期研究，但与目前使用类似损伤检测方法的调查结果一致。发现的损伤相关因素强化了先前研究的结果，同时也引发了未来研究的问题。
