Physicians' documentation of sexual abuse of children

To assess the quality of documentation by physicians in their evaluations for sexual abuse of children and to define factors that affect documentation.

Cross-sectional survey and blinded chart review.

A statewide program for child abuse evaluations.

Physicians (n = 145) who performed evaluations during fiscal year 1992-1993 were surveyed. Up to five randomly chosen medical records (n = 548), obtained from each eligible physician, were reviewed.

None.

A survey of physicians who participated in the statewide program was made in summer 1993, with 78% participation. Knowledge scores were derived from the survey based on a comparison with the responses of a panel of five experts. Charts that were obtained from eligible physicians were assessed by two blinded reviewers. Documentation of the history and physical examination was evaluated as good or excellent by 30% and 23% of the physicians, respectively. Factors that were positively associated with better documentation of the history included a more structured format for the record, continuing medical education courses on sexual abuse of children, female gender, and a history of disclosure (P < .005 for all). Factors that were related to good documentation of the physical examination included structured records, continuing medical education courses, female gender, and knowledge scores. Factors that were not related to knowledge or documentation included the number of evaluations performed, practice group size or location, age of the physician, and a physician's reading of journal articles about sexual abuse of children.

Quality of evaluations for sexual abuse of children may be improved by the use of structured records and participation in continuing medical education courses with regard to sexual abuse of children.