University of California, San Diego School of Medicine, Rady Children's Hospital, San Diego, CA, USA.
Child Abuse Negl. 2012 May;36(5):383-92. doi: 10.1016/j.chiabu.2012.01.004. Epub 2012 May 25.
(1) The purpose of this study was to assess the ability of clinicians who examine children for suspected sexual abuse to recognize and interpret normal and abnormal ano-genital findings in magnified photographs using an online survey format. (2) Determine which factors in education, clinical practice, and case review correlate with correct responses to the survey questions.
Between July and December 2007, medical professionals participated in a web-based survey. Participants answered questions regarding their professional background, education, clinical experience, and participation in case review. After viewing photographs and clinical information from 20 cases, participants answered 41 questions regarding diagnosis and medical knowledge. Answers chosen by an expert panel were used as the correct answers for the survey.
The mean number of correct answers among the 141 first-time survey respondents was 31.6 (SD 5.9, range 15-41). Child Abuse Pediatricians (CAP) had mean total scores which were significantly higher than Pediatricians (Ped) (34.8 vs. 30.1, p<0.05) and Sexual Assault Nurse Examiners (SANE) (34.8 vs. 29.3, p<0.05). The mean total scores for Ped, SANE, and Advanced Practice Nurses (APN) who examine fewer than 5 children monthly for possible CSA were all below 30. Total score was directly correlated with the number of examinations performed monthly (p=0.003). In multivariable regression analysis, higher total score was associated with self-identification as a CAP, reading The Quarterly Update newsletter (p<0.0001), and with quarterly or more frequent expert case reviews using photo-documentation (p=0.0008).
Child Abuse Pediatricians, examiners who perform many CSA examinations on a regular basis, examiners who regularly review cases with an expert, and examiners who keep up to date with current research have higher total scores in this survey, suggesting greater knowledge and competence in interpreting medical and laboratory findings in children with CSA. Review of cases with an expert in CSA medical evaluation and staying up to date with the CSA literature are encouraged for non-specialist clinicians who examine fewer than 5 children monthly for suspected sexual abuse.
（1）本研究旨在评估检查疑似性虐待儿童的临床医生使用在线调查格式识别和解释放大照片中正常和异常肛门生殖器发现的能力。（2）确定教育、临床实践和案例回顾中的哪些因素与正确回答调查问题相关。
在 2007 年 7 月至 12 月期间，医疗专业人员参加了一项基于网络的调查。参与者回答了关于他们的专业背景、教育、临床经验和参与案例审查的问题。在查看了 20 个案例的照片和临床信息后，参与者回答了 41 个关于诊断和医学知识的问题。专家小组选择的答案被用作调查的正确答案。
141 名首次调查受访者的平均正确答案数为 31.6（标准差 5.9，范围 15-41）。儿童虐待儿科医生（CAP）的总得分平均值明显高于儿科医生（Ped）（34.8 对 30.1，p<0.05）和性侵犯护士检查者（SANE）（34.8 对 29.3，p<0.05）。每月检查可能 CSA 的儿童少于 5 名的儿科医生、SANE 和高级实践护士（APN）的总得分平均值均低于 30。总得分与每月进行的检查次数直接相关（p=0.003）。在多变量回归分析中，更高的总得分与自我识别为 CAP、阅读《季度更新通讯》（p<0.0001）以及使用照片记录进行每季度或更频繁的专家案例审查（p=0.0008）相关。
儿童虐待儿科医生、定期对大量 CSA 进行检查的检查人员、定期与专家一起审查案例的检查人员以及与最新 CSA 研究保持同步的检查人员在本调查中的总得分较高，表明他们在解释 CSA 儿童的医学和实验室发现方面具有更高的知识和能力。鼓励每月检查疑似性虐待儿童少于 5 名的非专家临床医生对 CSA 医学评估案例进行专家审查，并与 CSA 文献保持同步。
