Child sexual assault reported to an acute sexual assault referral centre in London

Interpretation of medical findings in suspected child sexual abuse: An update for 2023

Health care professionals who examine children who may have been sexually abused need to be able to recognize, and photo-document any physical signs, and to have access to expert reviewers, particularly when signs concerning for sexual abuse are found. Although the general consensus among practitioners is that children will show few signs of sexual abuse on examination, there is considerable variability and rates of positive exam findings among practitioners of different professions, practice settings, and countries. This review will summarize new data and recommendations regarding the interpretation of medical findings and sexually transmitted infections (STIs); assessment and management of pediatric patients presenting with suspected sexual abuse or assault; and testing and treating patients for STIs. Updates to a table listing an approach to the interpretation of medical findings are presented, and reasons for changes are discussed.

Child sexual abuse detection in the pediatric emergency room

BACKGROUND

Children who report sexual abuse are often first evaluated in a Pediatric Emergency Room (ER).

OBJECTIVE

This study aims to describe clinical characteristics and management among these children.

PARTICIPANTS AND METHODS

A retrospective review of child sexual abuse (CSA) cases in the ER of a tertiary hospital in Madrid over a 9-year period (January 2011 to April 2020) was conducted. 213 children up to 16 years old were included. Descriptive statistics were performed.

RESULTS

An 83% of victims were girls, of whom 97.7% reported physical contact. The mean age was 8.5 ± 4.4 years, with two peaks of incidence at ages of 3 and 13. Aggressors were known by the victim in 77.8% of cases. Anogenital lesions were present in 39.9% of children who described physical contact, of which 31.7% were suspicious or specific of CSA. We obtained positive microbiological samples in 41 patients, with 14.6% specific findings for sexually transmitted infections (STIs). 23,9% received prophylaxis for bacterial STIs and 13.6% against HIV. 59.6% were followed-up in outpatient clinics. Since our protocol renovation in 2019, we observe a statistically significant increase in microbiological detection (p < .005) and outpatient follow-up (p < .001).

CONCLUSIONS

STIs screening should always be done when physical contact is reported for eventual treatment and perpetrator prosecution, as physical lesions are frequently not found. The optimal treatment of CSA requires the use of renewed specific protocols and the involvement of multidisciplinary trained teams to ensure adequate medical and personal care.

The association between victim-offender relationship and the age of children and adolescents who suffer sexual violence: a cross-sectional study

OBJECTIVES

Sexual violence is a problem that affects children and adolescents regardless of social class, age, origin, religion, education level, marital status, race, or sexual orientation. This study aimed to analyze the associations between victim-offender relationships and the victim's age in cases of sexual violence involving female victims.

METHODS

This cross-sectional, retrospective observational study used data from the Brazilian Ministry of Health's Department of Public Health Surveillance in Brasília regarding the reportable crime of rape as informed by female victims in the Federal District between January 1, 2012, and December 31, 2018. The age of the victim was classified as <15 years or 15-19 years. The offenders were classified into eight different categories according to their relationship with the victim: father, stepfather, brother, husband, boyfriend, friend, stranger, and others. The association between the victim-offender relationship and the victim's age was assessed.

RESULTS

Overall, there were 4,617 reported cases of sexual violence, with 78.3% of these (n = 3614) corresponding to children under 15 and 21.7% to adolescents 15-19 years old (n = 1003). Close relatives, including brothers, and friends were the main perpetrators in cases of girls < 15 years old. Strangers and friends were the principal perpetrators in the group of girls 15-19 years old.

CONCLUSIONS

Children under 15 are the group most affected by sexual violence. Strategies must be developed to prevent the sexual abuse of children and adolescents and to facilitate the rehabilitation of victimized children.

Comparison of Intentional and Unintentional Injuries Among Chinese Children and Adolescents

BACKGROUND

The patterns and risk factors of intentional injuries compared to unintentional injuries among Chinese children and adolescents have not been examined in depth. This work comprehensively describes patterns of intentional injuries in China, for which little information has been previously published.

METHODS

All cases involving individuals 0-17 years old registered at emergency rooms and outpatient clinics were examined using data submitted to the National Injury Surveillance System from 2006 through 2017. A logistic regression model was performed to explore the risk factors related to intentional injuries compared to unintentional injuries.

RESULTS

A total of 81,459 (95.1%) unintentional injuries, 4,218 (4.9%) intentional injuries (4,013 violent attacks and 205 self-mutilation/suicide) cases were identified. Blunt injuries accounted for 59.4% of violent attacks, while cuts and poisoning accounted for 37.1% and 23.4% of injuries involving self-mutilation/suicide, respectively. For unintentional injuries, falls (50.4%) ranked first. Additional risk factors for intentional injuries included being male (odds ratio [OR] 1.6), coming from rural areas (OR 1.9), being staff or workers (OR 2.2), and being a student (OR 1.8). As the age of the patients increased, so did the risk of intentional injuries (OR 5.0 in the 15-17 age group). Intentional injuries were more likely to occur at 00:00-03:00 am (OR 2.0).

CONCLUSIONS

Intentional injuries affected more males, rural and older children, school students, and staff or workers. The mechanisms and occurrence times differed according to age group. Preventive measures should be taken to reduce the dropout of rural students, strengthen the school's violence prevention plan, and reduce self-harm.

Clinical characteristics of children presenting with a suspicion or allegation of historic sexual abuse

INTRODUCTION

Police-recorded sexual offences against children and young people (CYP) increased 85% in the UK between 2010/2011 and 2014/2015. Many children delay disclosure, but little data are available regarding characteristics of CYP presenting with historic child sexual abuse (CSA).

AIM

To identify the clinical and CSA-related characteristics of CYP presenting with a suspicion or allegation of historic CSA.

METHOD

Data were collected on all CYP<17 years presenting with suspected or alleged historic CSA (ie, >3 days since last sexual assault in prepubertal children, >7 days pubertal girls) between October 2009 and November 2014.

DATA COLLECTED

source and indication for referral, alleged perpetrator, physical findings. Findings supportive of CSA were peer reviewed for consensus agreement.

ANALYSIS

χ² test, Fisher's exact test and logistic regression.

RESULTS

Among 249 CYP, presentation with physical/behavioural symptoms was associated with age <13 years (p<0.01), and alleged penetration with ages 13-17 years (p<0.01). Where known, time since alleged CSA ranged from 1 week to 13 months. Anogenital findings supportive of CSA were present in 7% of examined children (16/233), significantly associated with alleged penetration (p<0.01) and more likely with increasing age (OR 1.46, 95% CI 1.23 to 1.72). Additionally, where tested, sexually transmitted infections (STI) were detected in 2.6% CYP (3/116). Alleged perpetrators were intrafamilial in 66% (126/190). No associations were identified between perpetrator type and gender (p=1.0), age (p=0.7) or indication for referral (p=0.35).

CONCLUSIONS

Despite significant time delay since the alleged CSA, this study highlights the persistence of anogenital findings supportive of CSA in 7% and STIs in 2.6% of CYP.