Alyce Horstman^1,2, J Anne S Smith^1,2, Richard B Bassed^2,3, Lyndal Bugeja²

¹Victorian Forensic Paediatric Medical Service, Royal Children’s Hospital, Melbourne, Australia; ²Department of Forensic Medicine, Monash University, Melbourne, Australia; ³Victorian Institute of Forensic Medicine, Melbourne, Australia

 

Background: Paediatricians play a vital role as expert witnesses in child maltreatment cases, providing insights on injury mechanisms, timelines, and consequences. However, the impacts of testifying on paediatricians remain underexplored.

Objective: This review aimed to systematically identify and synthesize research on the benefits and harms to paediatricians resulting from testifying in such cases.

Methods: A systematic scoping review was conducted following PRISMA-ScR guidelines.

Results: Testifying poses significant psychological and professional challenges for paediatricians. Individually, they face stress and anxiety, driven by fears of discreditation and litigation. Negative interactions with legal professionals, including harsh cross-examinations and scheduling difficulties, further compound these challenges and can affect future reporting of child maltreatment. Professionally, testimony disrupts clinical duties, incurs financial losses, and is hindered by insufficient training.

Conclusion: Evidence on the impacts of testifying in child maltreatment cases is limited and varied. There are significant gaps in the literature. However, the available findings indicate a considerable psychological, professional, and logistical burden for paediatricians who testify in cases of child maltreatment. 

Anousha Victoire^1,2,3, Gemma Halliday², Shalu Singh², Parker Magin^3,4, Lyndal Bugeja⁵.

¹PhD candidate, Monash University, Melbourne, Australia; ²Hunter New England Health, Newcastle, Australia; ³School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; ⁴University of New South Wales, Sydney, Australia.

Photography has an increasing role in clinical documentation in forensic sexual assault examinations. In settings where specialist photographers are not available, clinician confidence in image capture will affect the uptake of photography as a clinical tool. A regional Australian health district with multiple sexual assault services, with previously low uptake of photography in clinical documentation of injury, introduced service smartphone cameras. Policy compliant procedures ensured appropriate use of smartphones to capture and store images, and training provided to forensic examiner staff. Routinely collected data around photography use was extracted before and after introduction of the new devices. The service saw a significant increase in use of photography in cases with injury after introduction of smartphones. A clinician survey of attitudes towards and factors affecting use of photography was conducted pre and post implementation, and demonstrated that once smartphones were introduced, clinicians no longer experienced barriers to use of photography around confidence and experience in image capture or device complexity, but focused more on injury factors and patient factors. Smartphones may be particularly useful for rural and regional settings where clinicians may have a low case load and no access to specialist medical photographers.

Vanita Parekh^1
1Canberra Hospital 

ABSTRACT Background People who report sexual assault express concerns regarding contracting sexually transmitted infection (STI); however, published literature regarding the risk of STI transmission in this context is sparse. Method We audited STI and blood-borne virus (BBV) testing at a forensic and medical sexual assault care service in the Australian Capital Territory between 2004 and 2022. Eligibility for testing among 1928 presentations was defined based on risk (eg, reported penetration). Testing at presentation included chlamydia and gonorrhoea 1850, syphilis and BBV 1472, and after 2–6 weeks, 890 out of 1928 (46.2%) and after 3 months 881 out of 1928 (45.7%), respectively. Results At presentation, 100 out of 1928 (5.2%) individuals were diagnosed with chlamydia, of those, 95 out of 1799 (5.3%) were female, and 5 out of 121 (4.1%) were male. Gonorrhoea was diagnosed in 7 out of 1920 (0.4%), 5 out of 95 female and 2 out of 5 male. Hepatitis B, which was all pre-existing, was diagnosed in 5 out of 1799 (0.3%). Overall, chlamydia prophylaxis was given to 203 out of 1928 (10.5%) and HIV postexposure prophylaxis to 141 out of 1928 (7.3%). At 2–6 weeks of follow-up, 10 out of 890 (1.1%) individuals were diagnosed with chlamydia, with no gonorrhoea diagnosed. There were no cases of syphilis, hepatitis B or HIV diagnosed at 3-month serology testing in 881 individuals. Chlamydia detection at follow-up was more common in the group aged 15–29 years. Of those provided with chlamydia prophylaxis, 203 out of 1928, only 16 out of 203 (7.9%) were diagnosed with chlamydia. Conclusions The offer of STI testing is almost universally accepted by individuals presenting for postsexual assault care. There were no identifiable factors to justify the routine use of chlamydia prophylaxis. STI testing provided an opportunity for screening and should remain part of the clinical care of people who report sexual assault.