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Reflex and dilatation: a clinical epidemiological evaluation.

I M Harvey¹, W A Nowlan

¹Department of Epidemiology and Community Medicine, University of Wales College of Medicine, Cardiff, UK.

Paediatric and Perinatal Epidemiology

|July 1, 1989

Summary

The reflex anal dilatation (RAD) sign

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Area of Science:

Forensic Medicine
Clinical Diagnostics
Pediatric Medicine

Background:

The reflex anal dilatation (RAD) sign is controversial in suspected sexual abuse cases.
Clinicians face challenges in selecting appropriate diagnostic tools.
Evidence for RAD's diagnostic accuracy is incomplete, particularly its specificity.

Purpose of the Study:

To quantitatively examine the performance of the RAD sign.
To evaluate RAD's positive predictive value under different prevalence scenarios.
To inform clinical practice regarding the use of RAD in suspected child sexual abuse.

Main Methods:

Quantitative analysis of RAD test performance.
Modeling of positive predictive value based on varying specificity and prevalence.
Review of existing evidence on RAD sign accuracy.

Main Results:

High specificity (≥99%) is required for a 90% positive predictive value of RAD at a 13% prevalence of anal abuse.
Even higher specificity (≥99.99%) is needed for a similar positive predictive value at a low prevalence (<0.5%) in the general child population.
The RAD sign's utility is highly dependent on the pre-test probability of anal abuse.

Conclusions:

The RAD sign has limited diagnostic value in suspected sexual abuse due to uncertain specificity.
Clinical interpretation of RAD must consider the prevalence of anal abuse.
Further research is needed to establish definitive diagnostic criteria for RAD.

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