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Perineal impalements in children: distinguishing accident from abuse
Naomi F Sugar1, Kenneth W Feldman
1Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA, USA. nsugar@u.washington.edu
Insights
Accidental perineal impalement injuries in children are uncommon but can cause severe internal damage, even with minor external signs. Medical evaluation, scene investigation, and witness accounts are crucial for diagnosis.
Area of Science:
- Pediatric Trauma
- Child Abuse Evaluation
- Forensic Medicine
Background:
- Perineal impalement injuries in children are rare but potentially severe.
- Evaluating these injuries requires careful consideration of potential child abuse.
- This study focuses on accidental pediatric perineal impalements.
Observation:
- A retrospective case series of 34 accidental pediatric perineal impalements was analyzed.
- Injuries occurred in children aged 13 months to 14 years, with 59% being girls.
- Most incidents happened at home (71%), often in the bathroom (38%).
Findings:
- Seventy-seven percent of children required examination under anesthesia.
- Fifty-nine percent needed surgical repair, and 4 cases involved bowel perforations.
- Multidisciplinary child abuse assessments were conducted in 71% of cases, with scene or object investigation in 50%.
Implications:
- Accidental perineal impalements can result in significant internal injuries despite minimal external findings.
- Thorough history taking from children, adults, and witnesses is essential.
- Medical providers must collaborate with child protection agencies and law enforcement when necessary to determine the nature of the injury.
Unlabelled:
Perineal impalements are uncommon and potentially life-threatening injuries. Medical providers must evaluate the risk of child abuse in all cases of genital or anal trauma. Determination of abuse depends on medical assessment of the mechanism of injury and statements by the child and witnesses, and may require collaboration with police or child protection agencies for scene investigation.
Objective:
To describe circumstances, medical findings, and child protection issues raised in accidental pediatric perineal impalement injuries.
Methods:
Retrospective case series selected from the authors' own practices and from submissions through an international list-serve of child abuse physicians. All cases included were determined to be accidental.
Results:
Thirty-four cases were identified. Children ranged in age from 13 months to 14 years, 59% were girls. Most injuries occurred in the home (24/34, 71%), and more than one third (13/34, 38%) occurred in the bathroom. Most children had examination under anesthesia (26/34, 77%), many required surgical repair (20/34, 59%), and 4 had bowel perforations. Multidisciplinary assessment regarding child abuse was used in 71% (24/34) of cases. Inspection of the impaling objects or the scene was accomplished by medical providers or police in 50% (17/34) of cases.
Conclusions:
Ambulatory children can sustain accidental perineal impalement injuries, and severe internal injuries may accompany minor external findings. History from supervising adults and from other child witnesses, examination of the impaling objects, and investigation of the scene may be required to reach the conclusion of accidental injury.
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