ABSTRACT
Introducción: Los conflictos familiares podrían ser una de las causas del incremento delas consultas a urgencias por sospecha de abuso sexual. El objetivo de este trabajo es describir las características de los niños valorados en urgencias por sospecha de abusosexual. Método: Revisión retrospectiva de los casos valorados durante los primeros 7 meses de2004.Resultados: Se atendieron 48 consultas, dos por abuso agudo. La edad media fue de6,8 (SD 3,6 años), 42 fueron niñas. En el 85,4% la exploración física fue normal. Se completó el estudio en la Unidad multidisciplinar específica en 37 pacientes, 25 tenían a los padres separados. En 10 niñas el diagnóstico fue de abuso. Todos los agresores fueron hombres, principalmente familiares. No se hallaron diferencias entre la conclusión de abuso y el sexo del paciente, la presencia de una exploración física normal y la situación de separación de los padres. Conclusiones: En urgencias es difícil evaluar adecuadamente las consultas por abuso sexual. La mayoría no requieren actuación inmediata, y es imprescindible la actuación coordinada con Unidades multidisciplinares especializadas, que confirman un tercio delos casos. Las niñas son las principales víctimas y el agresor, una persona conocida (AU)
Background: Family conflicts may be one of the reasons for the increase in visits for suspected child sexual abuse in Emergency Departments. The aim of the study was to report the characteristics of the children who present to Emergency Department with suspected sexual abuse. Methods: Retrospective review of all the children evaluated for suspected sexual abuse in the Emergency Department during the first seven months of 2004.Results: A total of 48 patients were attended two for acute sexual abuse. The mean age was 6.8 years (SD 3.6 years),42 were girls. Physical examination was normal in 85.4%. The study was completed in the Multidisciplinary Abuse Unit in 37 patients; 25 of when had divorced parents. In 10 girls sexual abuse was established. All rapists were men, mainly relatives of the children. No differences were found in the diagnoses of abuse, patient sex, normal physical examination or the divorced state of the parents. Conclusions: Confirmation of suspected sexual abuse in the Emergency Department is difficult. Most cases do not require immediate intervention and cooperation with a Multidisciplinary Abuse Unit is necessary. One third of child abuse suspicions are confirmed. The victims are mainly girls and the aggressors are usually persons close to the children (AU)
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Child Abuse, Sexual/statistics & numerical data , Child Abuse, Sexual/therapy , Emergency Medical Services/statistics & numerical data , Retrospective Studies , Spain/epidemiologyABSTRACT
OBJECTIVE: To describe the clinical findings in children treated in a child sexual abuse unit. PATIENTS AND METHODS: We carried out a retrospective study of the clinical histories of children under suspicion of sexual abuse who visited the hospital from January 1992 to April 2000. Data on age, sex, need of urgent medical care, means of arrival, mechanism of discovery of abuse, parental separation, anamnesis, physical findings and complementary investigations were collected. The patients were then classified in four groups: normal, compatible, highly probable or certain sexual contact. In cases with a high probability of abuse, data of the aggressor's identity, place, duration and type of abuse were also collected. RESULTS: We studied 704 patients. Seventy-five percent were girls. The child's account of events was the most frequent means of discovering abuse (51%). Anamnesis was positive in 45% of the patients, genital examination was normal in 74% and anal examination was normal in 79%. According to our classification, 40% of the patients were normal, 11% were compatible, 41% were highly probable and 4% were of certain sexual contact. Ninety-two percent of aggressors were male. Molestation was the most frequent form of abuse and in 25% of cases abuse took place for more than 1 year. CONCLUSION: Diagnosis of sexual abuse is difficult and is almost always based on the child's account of events. The diagnostic yield of physical examination and complementary investigations is very low. We propose a diagnostic classification of four levels: normal, compatible, highly probable abuse and certain sexual contact.
Subject(s)
Child Abuse, Sexual , Child , Child Abuse, Sexual/classification , Child Abuse, Sexual/diagnosis , Female , Humans , Male , Retrospective StudiesABSTRACT
Twenty-eight cases of urinary tract infection in newborns with positive urinoculture and suggestive clinical symptomatology are reviewed. The incidence was 0.24%, being most frequent in preterm and postterm newborns. Male neonates was more affected. Failure to thrive, excessive weight loss, poor feeding, diarrhoea, vomiting and jaundice are the most relevant clinical signs. E. coli and Klebsiella are the most frequent organism isolated, followed by Enterobacter and Candida. The presence of metabolic acidosis and leukocituria using a bag technique were the most accurate laboratory data to suspect a urinary tract infection.
