title: Anogenital injuries in child pedestrians run over by low-speed motor vehicles: four cases with findings that mimic child sexual abuse.
abstract: OBJECTIVE
  Differentiating between child sexual abuse and nonintentional causes of anogenital injury can be challenging, and a misdiagnosis can have a profound impact on the child and family. This case series documents an important nonintentional mechanism of anogenital injury that mimics the physical findings of child sexual abuse.
  
  
  METHODS
  Four children were examined after being run over by a slow-moving motor vehicle. In each case, the wheel of the vehicle passed longitudinally over the child's torso.
  
  
  RESULTS
  Two children had perianal lacerations, and 2 had hymenal lacerations. One child with hymen injuries was followed for 4 weeks and developed findings identical to those seen in healed sexual abuse.
  
  
  CONCLUSIONS
  Children run over by motor vehicles should be evaluated for anogenital injury. If such injury is suspected, it should be fully delineated and documented with colposcopy and follow-up examination. Although the possibility of sexual abuse must be considered, awareness of the occurrence of anogenital injuries in children run over by motor vehicles may prevent the misdiagnosis of acute sexual abuse in children. Conversely, children presenting for evaluation of acute or past sexual abuse should be questioned as to whether they were ever run over by a motor vehicle.
authors.affiliation: Department of Pediatrics, Armed Forces Center for Child Protection, National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Boos
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Rosas
authors.forename: Cathy
authors.initials: C
authors.lastname: Boyle
authors.forename: John
authors.initials: J
authors.lastname: McCann
mesh_terms: D000063:Accidents, Traffic; D001003:Anal Canal / Q000293:injuries*; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D003127:Colposcopy; D003937:Diagnosis, Differential; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D005836:Genitalia, Female / Q000293:injuries*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D006924:Hymen / Q000293:injuries; D022125:Lacerations / Q000209:etiology; D008099:Liver / Q000293:injuries; D055370:Lung Injury; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000209:etiology*; D010388:Pelvis / Q000293:injuries; D010413:Penis / Q000293:injuries*