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Pediatr Radiol. 2018 Aug;48(8):1048-1065. doi: 10.1007/s00247-018-4149-1. Epub 2018 May 23.

Consensus statement on abusive head trauma in infants and young children.

Author information

1
Department of Radiology, Nemours AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA. ac0026@nemours.org.
2
Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
3
Department of Radiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
4
New York University School of Medicine, New York, NY, USA.
5
Department of Medical Imaging, Primary Children's Hospital, Intermountain Healthcare, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
6
Division of Child Abuse Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
7
Florida International University College of Law, Miami, FL, USA.
8
Departments of Neurosurgery and Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA.
9
Department of Pediatrics, Child Abuse and Neglect Prevention, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
10
Department of Radiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
11
Department of Radiology, Boston Children's Hospital, Boston, MA, USA.
12
Pediatric Neuroradiology, Children's Healthcare of Atlanta, Scottish Rite Campus, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA.
13
Department of Radiology, University Hospital of Heraklion, University of Crete, Crete, Greece.
14
Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy.
15
Paediatric Musculoskeletal Imaging, Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, Western Bank, University of Sheffield, Sheffield, UK.

Abstract

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.

KEYWORDS:

Abusive head trauma; Child abuse; Children; Computed tomography; Consensus statement; Infants; Magnetic resonance imaging; Mimics; Unsubstantiated theories

PMID:
29796797
DOI:
10.1007/s00247-018-4149-1
[Indexed for MEDLINE]
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