Conclusion

(Chapter 5, pg. 58-59)

Formulating a Conclusion

The diagnosis of sexual abuse is based on the child's history, physical findings and laboratory and evidentiary test.

Before forming a conclusion, explore the following questions:

1. Can any or all of the physical findings be corroborated by the history?
2. Have alternative explanations for the trauma been considered and are they plausible?
3. Have all the diagnostic and forensic tests been completed and the results reviewed prior to coming to a conclusion?

Recommended Concluding Options

Careful wording of conclusions is especially important in cases involving potential abuse. Following are suggested wordings for a variety of clinical scenarios:

• The history or behavior is descriptive of inappropriate sexual contact, yet no residual is evident - the physical examination neither confirms nor denies sexual abuse.
• The history or behavior reflects inappropriate sexual contact, yet the residual at the time of the physical examination is nonspecific.
• The history or behavior is descriptive and specific findings are present - clear evidence of blunt force penetrating trauma consistent with sexual abuse.
• Identification of a healed injury on examination with no prior suspicion of abuse for which no historical or behavioral indicators are present.
• The child presents with a concern by a parent/caretaker without historical or behavioral details to support the concern.
  
• The child presents with an unexplained sexually transmitted disease.

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