Perineal impalements in children: distinguishing accident from abuse.
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.
Sugar
Naomi F
NF
Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA, USA. nsugar@u.washington.edu
Feldman
Kenneth W
KW
D000058:Accidental Falls; D000061:Accidents, Home; D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010502:Perineum / Q000293:injuries*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology*