[Diagnostics and Significance Evaluation in Cases of Suspected Child Sexual Assault - An Analysis of 210 Cases]. / Diagnostik und Signifikanzbeurteilung bei Verdacht auf sexuelle Gewalt im Kindes- und Jugendalter.

BACKGROUND: Child sexual abuse is difficult to diagnose in children and it is a challenging task for all involved medical disciplines of a medical child protection unit. The present study describes the factors that led patients to be presented to a child protection unit under the suspicion of sexual abuse and the diagnostic instruments which were used in order to substantiate or prove suspicious fact. PATIENTS AND METHOD: This study was conducted retrospectively on the basis of 210 children and adolescents ranged in age between 4 months and 18 years, who were presented to the medical child protection unit of Frankfurt am Main with suspected sexual abuse in the period from 2010 to 2015. 173 cases were analyzed in more detail. The cases were analyzed with the help of standardized documentation sheet and suspicious facts were evaluated with regard to their significance. RESULTS: A total of 173 patient records were analyzed in more detail containing cases of suspected child sexual abuse. The majority of the children and teenager were female and younger than 10. Often the father was accused of sexual abuse and parents were separated or in custody battle. The patient's statements were crucial for substantiation of suspicious fact in 60% of the cases. The assessment was more certain if the alleged perpetrator was not part of the close family and if other forms of physical violence were associated. CONCLUSION: The study shows that gynecological respectively anogenital findings do not represent the key evidence for the substantiation of sexual abuse allegations. Instead, it underlines the significance of further diagnostic methods, in particular the psychological and anamnestic evaluation.

Abusive head trauma: experience improves diagnosis.

PURPOSE: The diagnosis of abusive head trauma (AHT) is complex and neuroimaging plays a crucial role. Our goal was to determine whether non-neuroradiologists with standard neuroradiology knowledge perform as well as neuroradiologists with experience in pediatric neuroimaging in interpreting MRI in cases of presumptive AHT (pAHT). METHODS: Twenty children were retrospectively evaluated. Patients had been diagnosed with pAHT (6 patients), non-abusive head trauma-NAHT (5 patients), metabolic diseases (3 patients), and benign enlargement of the subarachnoid spaces (BESS) (6 patients). The MRI was assessed blindly, i.e., no clinical history was given to the 3 non-neuroradiologists and 3 neuroradiologists from 2 different institutions. RESULTS: Blindly, neuroradiologists demonstrated higher levels of sensitivity and positive predictive value in the diagnosis of pAHT (89%) than non-neuroradiologists (50%). Neuroradiologists chose correctly pAHT as the most probable diagnosis 16 out of 18 times; in contrast, non-neuroradiologists only chose 9 out of 18 times. In our series, the foremost important misdiagnosis for pAHT was NAHT (neuroradiologists twice and non-neuroradiologists 5 times). Only victims of motor vehicle accidents were blindly misdiagnosed as pAHT. No usual household NAHT was not misdiagnosed as pAHT. Neuroradiologists correctly ruled out pAHT in all cases of metabolic diseases and BESS. CONCLUSION: MRI in cases of suspected AHT should be evaluated by neuroradiologists with experience in pediatric neuroimaging. Neuroradiologists looked beyond the subdural hemorrhage (SDH) and were more precise in the assessment of pAHT and its differential diagnosis than non-neuroradiologists were. It seems that non-neuroradiologists mainly assess whether or not a pAHT is present depending on the presence or absence of SDH.