Related Experiment Videos
The interpretation of urogenital findings in children with straddle injuries
M D Dowd1, L Fitzmaurice, J F Knapp
1Section of Emergency Medicine, Children's Mercy Hospital, Kansas City, MO.
Insights
Straddle injuries are typically minor genital abrasions or lacerations. However, perianal, hymenal, or vaginal trauma may indicate a penetrating injury, necessitating a sexual assault investigation.
Area of Science:
- Pediatric Emergency Medicine
- Forensic Pediatrics
- Urogenital Trauma
Background:
- Urogenital trauma often raises concerns of sexual abuse.
- Understanding injury mechanisms is crucial for accurate assessment.
- Straddle injuries require careful evaluation to differentiate accidental trauma from assault.
Purpose of the Study:
- To characterize trauma resulting from straddling incidents.
- To correlate straddle injuries with patient history, examination findings, and characteristics.
- To identify indicators that may suggest sexual assault.
Main Methods:
- Retrospective chart review of 100 pediatric patients.
- Inclusion criteria: straddle injury (perineal blow from body weight).
- Data collected: age, sex, injury type, mechanism, and diagnosis.
Main Results:
- Most injuries (n=100) were minor genital lacerations/abrasions.
- 11% had posterior fourchette injury; hymenal/vaginal injuries suggested penetration.
- No urethral/perianal injuries from non-penetrating straddle mechanisms.
- 5 patients diagnosed with sexual assault based on disclosure and inconsistent findings.
Conclusions:
- Straddle injuries are usually minor urogenital trauma.
- Perianal, hymenal, or vaginal trauma suggests a penetrating mechanism (unintentional or assault).
- Sexual assault investigation is warranted for infants <9 months, penetrating injuries, severe trauma, or history/finding discrepancies.
Abstract:
Because urogenital trauma frequently raises the question of sexual abuse, it is important to be able to relate the mechanism of injury to expected examination findings. This study was undertaken to characterize the trauma that results from straddling and correlate such injuries with the history, examination, and patient characteristics. The charts of 100 patients examined in an urban pediatric emergency department were reviewed; their conditions met the criteria of straddle injury--a blow to the perineum as a result of falling or striking a surface or an object with the force of one's own body weight. Ages ranged from 9 to 187 months (mean, 77.9; median, 67.2); 72% were female. Most injuries were minor lacerations and abrasions of the genitalia. Eleven percent had injury to the posterior fourchette. Hymenal and vaginal injuries were primarily caused by penetrating mechanisms. Five patients who presented with a history of straddling subsequently received the diagnosis of sexual assault based on disclosure by the patient or a witness and inconsistency of physical findings. There were no urethral or perianal injuries resulting from nonpenetrating straddle mechanisms. Straddle injuries include a variety of mostly minor urogenital injuries. Perianal, hymenal, or vaginal trauma suggests a penetrating mechanism, either unintentional or from sexual assault. An investigation for sexual assault should be initiated in the following cases: infants younger than 9 months of age; perianal, hymenal, or vaginal injury; extensive or severe injury; concurrent nonurogenital injuries; and whenever there is lack of correlation between history and physical findings.