Battered child syndrome

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.

/pdf/consensus-statement-on-abusive-head-trauma-in-infants-and-3ju2zr814u.pdf

Consensus statement on abusive head trauma in infants and young children

Objective: The objectives of this study were to provide population-based incidence estimate of abusive head trauma (AHT) in children aged 0 to 5 years from inpatient and emergency department (ED) and identify risk characteristics for recognizing high-risk children to improve public health surveillance. Methods: This was a retrospective cohort study based on children's first encounter in ED or hospital admission with a diagnosis of head trauma (HT), 2000–2010. The relationship between clinical markers and AHT was examined controlling for covariables in the model using Cox hazards regression. Kaplan-Meier incidence probability was plotted, and the number of weeks elapsing from date of birth to the first encounter with HT established the survival time (T). Results: Twenty-six thousand six hundred eighty-one children had HT, 502 (1.8%) resulted from abuse; 42.4% was captured from ED. Incidence varied from 28.9 (95% confidence interval [CI], 27.9–37.4) in infants to 4.1 (95% CI, 2.4–5.7) in 5-year-olds per 100,000 per year. Adjusted hazard ratio was 20.3 (95% CI, 10.9–38.0) for intracranial bleeding and 11.4 (95% CI, 8.57–15.21) for retinal hemorrhage. Conclusions: Incidence estimates of AHT are incomplete without including ED. Intracranial bleeding is a cardinal feature of AHT to be considered in case ascertainment to improve public health surveillance.

Abusive head trauma in young children: a population-based study.

A child suspected of having an abusive head trauma (AHT) is referred by paediatricians to an ophthalmologist for evaluation. The incidence of abusive head injury in children is highest in infancy and less frequently seen in children over 3 years of age. Retinal haemorrhages (RHs) have a high positive predictive rate for abusive head injury. In the presence of head injury without any plausible medical explanation the description of the retinal findings help in distinguishing between abusive injury and other causes. It is incumbent on the ophthalmologist to be familiar with the clinical presentation, the differential diagnosis, and controversies associated with attributing the presence or absence of retinal findings to abusive head injury in children.

The guidance was developed by a guideline working party (GWP) from the Royal College of Ophthalmologists (RCO) and the Royal College of Paediatrics and Child Health (RCPCH). It brings together previous publications of the RCO1, 2, 3 and an update of the literature since these publications.

The publication is a summary of the updates of the full version of the document, with its appendices available on the websites of the RCO (www.rcophth.ac.uk) and the RCPCH (www.rcpch.ac.uk).

Abusive head trauma and the eye in infancy

ObjectiveThe objectives of this study were to provide population-based incidence estimate of abusive head trauma (AHT) in children aged 0 to 5 years from inpatient and emergency department (ED) and identify risk characteristics for recognizing high-risk children to improve public health surveillance

Paediatric abusive head injury may have grave consequences, especially when characterized by repetitive acceleration-deceleration forces (shaken baby syndrome) Death occurs in approximately 30% and permanent neurologic damage in up to 80% of the victims Retinal haemorrhages are a cardinal sign seen in approximately 85% of cases In most cases haemorrhages are preretinal, intraretinal and subretinal, too numerous to count, and involving the entire retinal surface extending to the ora serrata Traumatic macular retinoschisis is a lesion with important diagnostic significance Vitreoretinal traction appears to be the mechanism of haemorrhage and schisis formation along with a possible role of orbital tissue trauma from repetitive acceleration-deceleration forces Ophthalmologists must carefully document ocular findings Appropriate autopsy examination should include ocular and orbital tissue removal Although there is a wide differential diagnosis for retinal haemorrhages, clinical appearance, when considered in the context of systemic and laboratory findings, usually leads to the correct diagnosis Language: en

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1442-9071.2010.02291.x

Retinal haemorrhage in abusive head trauma.

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Retinal haemorrhage in abusive head trauma.