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Inter-rater reliability in the medical diagnosis of child sexual abuse
Objective:
To examine inter- and intra-rater reliability in the assessment of genital findings in cases of suspected child sexual abuse.
Methodology:
Colposcopic photographs of the external genitalia of 70 female children were independently assessed by child sexual abuse teams in Auckland and Sydney. For the Auckland centre, intra-rater reliability was assessed by making a second independent assessment 6 months following the first. Reliability was quantified using per cent of agreement and Cohen's Kappa statistic.
Results:
There were high levels of inter- and intra-rater agreement. When photographs were classified as normal/non specific or strongly indicative of child sexual abuse, there was 93% agreement between the Auckland and Sydney teams with a kappa score of 0.70. For the two separate ratings made by the Auckland team there was 94% agreement with a kappa score of 0.75.
Conclusions:
The high levels of inter- and intra-rater agreement obtained in this study were reassuring. The results obtained compare favourably with the results of reliability studies in other areas of medical practice.