Citation

Melville JD, Lindberg DM. Acad. Pediatr. 2019; ePub(ePub): ePub.

Affiliation

The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: DanielLindberg@ucdenver.edu.

Copyright

(Copyright © 2019, Academic Pediatric Association, Publisher Elsevier Publishing)

DOI

10.1016/j.acap.2019.12.010

PMID

31899328

Abstract

BACKGROUND AND OBJECTIVE: Child abuse pediatricians (CAPs) are often asked to determine the likelihood that a particular child has been sexually abused. These determinations affect medical and legal interventions, and are important for multi-site research. No widely accepted scale is available to communicate perceived sexual abuse likelihood. In this study, we measure intra- and inter-rater reliability of a 5-point scale to communicate child sexual abuse likelihood.

METHODS: We developed a 5-point scale of perceived likelihood of child sexual abuse with example cases and medical-legal language for each risk category. We then surveyed CAPs who regularly perform sexual abuse evaluations using the abstracted facts of 15 actual cases with concern for sexual abuse. A subset of participants rated the same vignettes again, one month later.

RESULTS: Of 512 invited participants, 240 (46.7%) responded, with 145 (28.3%) indicating that they regularly perform sexual abuse evaluations, 116 initially completing all 15 vignettes, and 36 completing repeat ratings at least one month later. The scale showed consistent stepwise increase in mean perceived likelihood of abuse and intention to report for each increase in scale rating. Inter-rater agreement was substantial (Fleiss' weighted kappa 0.64) and test-retest reliability among 36 participants was almost perfect (Cohen's kappa = 0.81).

CONCLUSIONS: We introduce a scale of perceived sexual abuse likelihood that appears to reflect CAPs' perceptions and intention to report. This scale may be a reasonable metric for use in multi-center studies. CAPs demonstrated substantial inter- and intra-rater reliability when evaluating sexual abuse likelihood in case vignettes. While this scale may improve communication of sexual abuse likelihood among experts, its examples should not be used as a legal standard or a clinical criterion for sexual abuse diagnosis.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

Agreement; Likelihood; Sexual Abuse