Brayden R M, Altemeier W A, Yeager T, Muram D
Department of Pediatrics, Vanderbilt University, Nashville, TN.
Child Abuse Negl. 1991;15(1-2):69-76. doi: 10.1016/0145-2134(91)90091-q.
Accurate assessment of physical findings for child sexual abuse is medically and legally important. This study evaluated (1) interobserver reliability of clinicians rating colposcopic photographs, and (2) correlates of reliable interpretations. Seventy physicians and two nurse practitioners, divided by professional levels, assessed colposcopic photographs and completed a questionnaire. Ratings by a professional with extensive experience in this field were used as an accuracy standard. Leaders in the field of child sexual abuse assessment made significantly more "accurate" assessments than pediatricians, pediatric and family practice residents, and intern physicians. Leaders made fewer "inaccurate" interpretations than interns. Predictors of agreement with standard assessments, although weak, were knowledge of female perineal anatomy and professional level. Total number of sexual abuse examinations conducted and knowledge of sexually transmitted diseases as acquired by children were not significant predictors of accurate assessment. The findings are interpreted as to their potential relevance to actual sexual abuse evaluations of children.
准确评估儿童性虐待的体格检查结果在医学和法律上都很重要。本研究评估了：（1）临床医生对阴道镜照片评分的观察者间可靠性，以及（2）可靠解读的相关因素。70名医生和两名执业护士按专业水平分组，评估阴道镜照片并完成一份问卷。将在该领域有丰富经验的专业人员的评分用作准确性标准。儿童性虐待评估领域的权威人士做出的“准确”评估明显多于儿科医生、儿科和家庭医学住院医师以及实习医生。权威人士做出的“不准确”解读比实习生少。与标准评估结果一致的预测因素虽然较弱，但包括女性会阴解剖学知识和专业水平。进行性虐待检查的总数以及儿童所获得的性传播疾病知识并非准确评估的重要预测因素。对这些研究结果进行了解读，以探讨其与儿童实际性虐待评估的潜在相关性。
