The Rational Clinical Examination
David L. Simel, Drummond Rennie
Sexual Abuse, Child
Molly Curtin Berkoff, Adam J. Zolotor, Kathi L. Makoroff, Jonathan D. Thackeray, Robert A. Shapiro, Desmond K. Runyan
Reporting Concerns to the Appropriate Agency
Topics Discussed:
children's health, conduct considerations, diagnostic process, examination of vagina, female genitalia, gynecological examination, hymen, pediatric discipline, physical examination, sexual abuse, sexual abuse of child, summarizing the evidence, vaginal discharge
Excerpt:
"Eleven articles met the inclusion criteria. Only 2 of these articles
included prepubertal girls with and without a history of sexual
abuse,28,29 allowing us to calculate LRs. None
of these articles included information allowing for the interpretation
of physical examination findings acutely (
72 hours of the event).
The remaining 9 articles only included prepubertal girls without
a history of sexual abuse, permitting estimation only of the specificity
of the findings.Sensitivity, specificity, and positive and negative LRs derived
from the 2 articles that included both populations of prepubertal
girls are included in Table 54-4. The signs of vaginal
discharge or the diameter of the hymenal opening were the only findings
where the 95% CIs for both the positive and negative LRs
excluded 1.0...."
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