Sexual abuse evaluations in the emergency department: is the history reliable?

The authors assessed agreement on perpetrator identification obtained at two interviews of child victims of sexual abuse. We reviewed charts for 141 children who had undergone both a screening interview by an emergency department physician and an investigative interview by an interdisciplinary team specializing in child sexual abuse evaluation. For 107 (76%) cases, information was consistent; for instance, identification occurred at both interviews or at neither interview. Of the 38 children not identifying the perpetrator at the screening interview, 17 (45%) made disclosure at the investigative interview. Children who made disclosure only at the investigative interview were more likely to have refused to speak to the physician in the emergency department (p = .001). No significant differences were found when data for interview site and perpetrator identification were analyzed by gender of child, time interval between assault and screening interview, time interval between the two interviews, relationship of the alleged perpetrator to the child, performance of the investigative interview on an inpatient versus outpatient basis, and report of genital contact. In conclusion, perpetrator identification obtained during emergency department screening interviews usually agreed with information obtained at the subsequent investigative interview. The investigative interview was most helpful in identification of perpetrators when the child was not the source of the history obtained in the emergency department.