Ethical issues in imaging nonaccidental injury: child abuse

Ethical Issues in Forensic Testimony Involving Abusive Head Trauma

Medical examiners provide critical diagnostic and testimonial information in abusive head trauma cases. Courtroom challenges to these diagnostic criteria and contested expert testimony have raised concerns about ethical and professional conduct of practitioners. Legal evidentiary standards for expert testimony, ethical guidelines established by medical organizations, and proposed standards for ethical practice provide a background for examination of several common challenges and testimonial claims in these cases.

Imaging of the central nervous system in suspected or alleged nonaccidental injury, including the mimics

Because of the widely acknowledged controversy in nonaccidental injury, the radiologist involved in such cases must be thoroughly familiar with the imaging, clinical, surgical, pathological, biomechanical, and forensic literature from all perspectives and with the principles of evidence-based medicine. Children with suspected nonaccidental injury versus accidental injury must not only receive protective evaluation but also require a timely and complete clinical and imaging workup to evaluate pattern of injury and timing issues and to consider the mimics of abuse. All imaging findings must be correlated with clinical findings (including current and past medical record) and with laboratory and pathological findings (eg, surgical, autopsy). The medical and imaging evidence, particularly when there is only central nervous system injury, cannot reliably diagnose intentional injury. Only the child protection investigation may provide the basis for inflicted injury in the context of supportive medical, imaging, biomechanical, or pathological findings.

Neuroimaging in non-accidental head injury: if, when, why and how

Non-accidental head injury (NAHI) in infants is an important but difficult topic. To miss or misdiagnose NAHI potentially has important consequences. The evidence base upon which to base decisions is limited but growing. This article aims to summarise current literature and thinking in this difficult area.