Pediatric emergency medicine trisk 4229 4229
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determination about forensic evidence collection, remember that the details
of the event can become more specific over time. The provider should
document the history source, a description of the event, and use quotations
when documenting the exact words from the patient’s disclosure when
possible. Document the witnesses present during the interview in the
medical record.
Perform and document a complete physical examination including all
injuries sustained. Perform the examination with a chaperone, regardless of
the gender of the patient or provider. This chaperone should be a trained
member of the medical staff who can assist in examination procedures and
serves as an unbiased witness. A parent or another familiar adult can remain
with the child to provide support and comfort. Distraction techniques, pain
control, anxiolysis, or sedation may be required in some situations. The
anogenital examination includes careful inspection of the penis and scrotum
in males, the mons pubis, the labia, vaginal opening, and hymen in females,
and the anus in all patients. A speculum or bimanual examination is rarely
required in adolescent patients. It may be indicated if there is significant
vaginal bleeding, or concern for a retained vaginal foreign body. It should be
avoided in prepubertal patients. Photo documentation of all injuries is
recommended. It is useful to photo document a normal genital examination
as well, to avoid risk of not detecting subtle, potentially forensic findings.
While a colposcope provides magnification for optimal visualization and
high-quality photo documentation, there are other digital health advances
that EDs are using that may obviate the need for this equipment. In specific,
digital photograph systems that are integrated with the electronic health
record are being used and provide excellent photo documentation with little
training required to provide diagnostic quality images for peer and quality
improvement review. Regardless of the equipment and system used, the
important caveat is: (1) all forensic examinations include photo
documentation that is conducted in a secure, protected fashion; and (2) photo
documentation is of diagnostic quality to adequately represent the
examination and potential findings. Written documentation detailing the
examination must be included in the medical record.
Of note, urgent physical examination is not required if the assault
occurred >72 hours prior to presentation, unless the child/adolescent has
ongoing symptoms including but not limited to, significant abdominal pain
