ASSESSMENTS OF GIRLS GENITAL FINDINGS AND THE LIKELIHOOD OF SEXUAL ABUSE - AGREEMENT AMONG PHYSICIANS SELF-RATED AS SKILLED

Objectives: To measure agreement about genital examination findings am ong physicians who rate themselves as skilled in evaluating children f or suspected sexual abuse, to compare these physicians' descriptions a nd interpretations with consensus standards developed by an expert pan el, and to investigate the effects of physician and case characteristi cs on agreement. Study Design: Questionnaires including 7 simulated ca ses, each consisting of a brief history and 1 photograph of a girl's g enitalia, were mailed to random samples of 2 groups: the members of 4 physician organizations concerned with child abuse or pediatric gyneco logy, and pediatricians at large. Among the surveyed physicians who ra ted their own skill in evaluating cases of suspected sexual abuse as h igher than average, we measured agreement, both overall and between th ose with the most and with less clinical experience, and assessed thei r conformity with consensus standard descriptions and interpretations. Results: We received responses from 548 (50.9%) of 1076 physicians; 4 14 responses (75.5%) were analyzable. Two hundred six physicians (50%) rated themselves as skilled in assessing children for sexual abuse. O n average, 45% of these physicians' descriptions and 72.6% of their in terpretations conformed with the consensus standards. In 4 cases, betw een 5% and 20.70%, of these physicians described genital findings that the expert panel had considered absent from the photographs. Conformi ty with standard interpretations tended to be higher in cases with pho tographs concordant with the accompanying, unambiguous histories (P = .06). The most experienced physicians resembled the expert panel more closely than did the less experienced self-rated skilled physicians in interpreting 3 simulated cases (P less than or equal to .001). Conclu sions: Assessments of girls' genital findings by physicians who rate t hemselves as skilled in examining children for suspected sexual abuse often differ. In some cases, among physicians who all rate themselves as skilled, assessments made by very experienced physicians may confor m more closely to consensus standards than do assessments made by less experienced physicians.