How do clinicians assess the level of risk of different indicators of Child Sexual Abuse?
Aims Children present with features that raise a suspected CSA in many different ways. This survey aims to assess the level of risk attached to different features of Child Sexual Abuse (CSA).
Methods An electronic survey was completed by a purposive sample of UK clinicians specialising in CSA assessment. The survey included 47 statements/scenarios commonly presenting in a case of possible CSA. The clinicians were asked to rank items according to level of perceived risk on a Likert Scale (0-5), ranging from no risk to definite CSA, an additional space for comment was available. The scenarios/statements were grouped into historical factors, clinical features and child protection outcome. A descriptive analysis of the responses was performed to identify the level of risk assigned to each scenario/statement.
Results 106 respondents participated in the survey of which 88.67% said they regularly conducted CSA examinations. The average ranking (with risk weighing) across all 49 statements was 421.3 (Range 188-575). Features fell into a spectrum of risk. Examples include Low risk: witnessed accidental injury (188), dysuria (223). Moderate risk: prepubertal vaginal discharge (297), perianal warts (362). High risk unprompted disclosure of CSA (505), STI in prepubertal child (543) pregnancy in under thirteen year old (569). Analysis of the respondents' comments highlighted the importance of factors such as age of the child and the association of multiple factors in decision making.
Conclusion There was a strong consensus amongst clinicians as to the weight given to specific factors when assessing the risk of CSA. This analysis has the potential to be developed further to i) inform a probabilistic model for defining the risk of CSA when features present in combination and ii) to inform a ranking for the security of diagnosis of CSA in future primary research studies to evaluate the physical signs of CSA in the absence of a “gold-standard diagnostic test for the condition.