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PEDIATRICS Vol. 112 No. 1 July 2003, pp. e77-e84

EXPERIENCE AND REASON

Anogenital Injuries in Child Pedestrians Run Over by Low-Speed Motor Vehicles: Four Cases With Findings That Mimic Child Sexual Abuse

Stephen C. Boos, MD*, Angela J. Rosas, MD{ddagger}, Cathy Boyle, PNP{ddagger}, John McCann, MD{ddagger}

* Department of Pediatrics, Armed Forces Center for Child Protection, National Naval Medical Center, Bethesda, Maryland
{ddagger} Department of Pediatrics, Child and Adolescent Abuse Resource and Evaluation Center, University of California Davis Medical Center, Sacramento, California

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.

Key Words: child sexual abuse • motor vehicle injury • genital injury • anal injury

Abbreviations: UCDCH, University of California Davis, Children’s Hospital • CAARE, Child and Adolescent Abuse Resource and Evaluation • CT, computed tomography • CPS, child protection services

Received for publication May 3, 2000; Accepted Mar 21, 2003.


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