Normal versus abnormal genital findings in children: how well do examiners agree?

In order to determine how well medical examiners agree on the significance of certain anogenital findings in children, preselected colposcopic photographs of the anogenital area of 16 patients were shown to 170 medical examiners (82% pediatricians) who were blinded as to the history on each patient. Findings rated most frequently as being suggestive or indicative of penetrating injury included immediate anal dilatation with no stool present (85%), hymenal transection (84%), marked narrowing of the hymenal rim with notching (81%), and a posterior fourchette scar (75%). The agreement between the participants and the experts on the abnormal cases (mean 81%) was significantly higher than on the normal cases (mean 71%, p < .001) and on genital findings (78%) than on anal findings (63%, p = .000). Higher experience level (more cases seen per month) was associated with significantly higher agreement between the participants and the experts on five of eight normal cases and two of four abnormal cases. Use of a colposcope was also associated with higher overall agreement with the experts (74% vs. 44%, p < .0001).