In Reply.—

We thank Dr Smith for his interesting perspective regarding screening for child abuse. We had hoped our article would help physicians focus on the verbal evidence of abuse and show how insensitive the physical evidence is in predicting which child had been abused sexually. To apply the principles of sensitivity and specificity to the assessment of child abuse or sexual abuse, we must have a gold standard which characterizes these problems. Neither a child protective services decision nor a legal determination of "no proven abuse" can be used as a gold standard, unless we can accept a "gold standard" made of iron pyrite.

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