儿童会阴部刺伤：区分意外与虐待。

Sugar Naomi F, Feldman Kenneth W

Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA, USA.

Pediatr Emerg Care. 2007 Sep;23(9):605-16. doi: 10.1097/PEC.0b013e318149f621.

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.

未标注

会阴部穿刺伤并不常见，且可能危及生命。医疗人员必须对所有生殖器或肛门创伤病例评估虐待儿童的风险。虐待的判定取决于对损伤机制的医学评估以及儿童和证人的陈述，可能需要与警方或儿童保护机构合作进行现场调查。

目的

描述小儿意外会阴部穿刺伤的情况、医学发现及儿童保护问题。

方法

从作者自身的病例以及通过虐待儿童医生国际名录提交的病例中选取回顾性病例系列。纳入的所有病例均判定为意外事故。

结果

共识别出34例病例。儿童年龄从13个月至14岁不等，59%为女孩。大多数损伤发生在家中（24/34，71%），超过三分之一（13/34，38%）发生在浴室。大多数儿童接受了麻醉下检查（26/34，77%），许多需要手术修复（20/34，59%），4例有肠穿孔。71%（24/34）的病例进行了关于虐待儿童的多学科评估。50%（17/34）的病例中，医疗人员或警方检查了穿刺物体或现场。