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Arneitz C, Schmitz J, Szilagyi I, Kienesberger B, Schalamon G, Senica SO, Schalamon J. Abusive head trauma and crying infant-Public awareness of newborn and infant trauma. Acta Paediatr 2024; 113:1569-1578. [PMID: 38634613 DOI: 10.1111/apa.17243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
AIM Crying seems to be a common trigger for abusive head trauma (AHT), which is the leading cause of fatalities from physical abuse in infants. Our objective was to evaluate knowledge of AHT, crying infants and correct behavioural measures in a general population. METHODS An online questionnaire (LimeSurvey) was created to assess the risk of shaking. The online survey contained a total of 41 questions, including a demonstration of a previously recorded video in which an infant doll is shaken. RESULTS A total of 319 people, 245 of them (76.8%) with own children, participated in the study. Almost all respondents (98.4%) were aware of serious injuries due to shaking, even to the point of death (98.1%). Most participants (97.5%) had heard the term 'shaking trauma' prior but did not receive any professional information, neither before nor after birth (85.2% or 86%), or during follow-up examinations (88.5%). The majority of the participants (95%) considered that useful coping strategies in infant crying were inappropriate. CONCLUSION The consequences of shaking an infant were common knowledge in a normal population, whereas there was a knowledge gap regarding the management of excessive crying infants. Prevention programmes should mainly focus on male caregivers during postnatal care.
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Affiliation(s)
- Christoph Arneitz
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
- Safe Kids Austria, Carinthian Branch, Klagenfurt, Austria
| | - Jana Schmitz
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Istvan Szilagyi
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Bernhard Kienesberger
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
| | - Georg Schalamon
- Department of Trauma Surgery, Clinic Diakonissen Schladming, Teaching Hospital of the Paracelsus Medical University, Schladming, Austria
| | - Simone Oliver Senica
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
| | - Johannes Schalamon
- Department of Pediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria
- Safe Kids Austria, Carinthian Branch, Klagenfurt, Austria
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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Expression of Concern: Medical findings and symptoms in infants exposed to witnessed or admitted abusive shaking: A nationwide registry study. PLoS One 2024; 19:e0306433. [PMID: 38935744 PMCID: PMC11210838 DOI: 10.1371/journal.pone.0306433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
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Shahraki K, Suh DW. An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse. CHILDREN (BASEL, SWITZERLAND) 2024; 11:586. [PMID: 38790581 PMCID: PMC11119297 DOI: 10.3390/children11050586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
Abusive head trauma (AHT) is an extreme form of physical child abuse, a subset of which is shaken baby syndrome (SBS). While traumatic injury in children is most readily observed as marks of contusion on the body, AHT/SBS may result in internal injuries that can put the life of the child in danger. One pivotal sign associated with AHT/SBS that cannot be spotted with the naked eye is retinal injury (RI), an early sign of which is retinal hemorrhage (RH) in cases with rupture of the retinal vasculature. If not addressed, RI can lead to irreversible outcomes, such as visual loss. It is widely assumed that the major cause of RI is acceleration-deceleration forces that are repeatedly imposed on the patient during abusive shaking. Still, due to the controversial nature of this type of injury, few investigations have ever sought to delve into its biomechanical and/or biochemical features using realistic models. As such, our knowledge regarding AHT-/SBS-induced RI is significantly lacking. In this mini-review, we aim to provide an up-to-date account of the traumatology of AHT-/SBS-induced RI, as well as its biomechanical and biochemical features, while focusing on some of the experimental models that have been developed in recent years for studying retinal hemorrhage in the context of AHT/SBS.
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Affiliation(s)
| | - Donny W. Suh
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine School of Medicine, Irvine, CA 92697, USA;
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Brodal P, Olaisen B, Rogde S. Shaken baby syndrome, due process and scientific disagreement. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:23-0128. [PMID: 37097247 DOI: 10.4045/tidsskr.23.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
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Brook C. Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data. Forensic Sci Int Synerg 2023; 6:100314. [PMID: 36691664 PMCID: PMC9860097 DOI: 10.1016/j.fsisyn.2023.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Independently witnessed events are used as a reference standard to robustly categorize accidental or non-abusive head trauma (non-AHT) cases in the pediBIRN data set of acutely symptomatic infants with closed head injuries. Findings in such independently witnessed non-AHT cases are compared to findings in cases that were diagnosed as AHT but were not independently witnessed. The data shows that 14% of independently witnessed non-AHT cases are misdiagnosed as AHT, and that risk factors for misdiagnosis include acute encephalopathy, bilateral or interhemispheric SDH, and/or severe retinal hemorrhages, findings that are commonly associated with AHT. The data also shows that "dense retinal hemorrhages extending to the periphery" are not highly suggestive of AHT, as they also occur in independently witnessed non-AHT cases.
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Why admitted cases of AHT make a low quality reference standard: A survey of people accused of AHT in France. Forensic Sci Int Synerg 2022; 6:100312. [PMID: 36632195 PMCID: PMC9826806 DOI: 10.1016/j.fsisyn.2022.100312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
Several influential articles that attempt to establish diagnostic methods for Abusive Head Trauma (AHT) use admitted cases as a reference standard. This study analyses a survey of people accused of AHT in France, to understand the environment and situations in which such admissions are made. Multiple reasons to question the reliability of admissions to AHT are demonstrated in the responses, including reduced sentences, the return of children to the family home, a desire to stop accusations being leveled at a partner and for legal proceedings to end. These factors must be considered in the context of proceedings that are long, expensive and stressful, leading to depression and financial hardship, and that seem to be inevitably heading towards conviction. The ineluctable conclusion is that admitted cases do not make a suitably reliable reference standard for undertaking scientific investigation, or for validating the diagnostic methods used for AHT.
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7
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Högberg U. How to sure that rib fractures and classical metaphyseal lesions are caused by traumatic shaking? Acta Paediatr 2022. [PMID: 35545814 DOI: 10.1111/apa.16402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Ulf Högberg
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
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Squier W. Infant retinal haemorrhages correlate with chronic subdural haemorrhage, not shaking. Acta Paediatr 2022; 111:714-715. [PMID: 34766369 DOI: 10.1111/apa.16169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Waney Squier
- Formerly Department of Neuropathology West Wing John Radcliffe Hospital Oxford UK
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Wester K, Stridbeck U, Syse A, Wikström J. Re-evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses. Acta Paediatr 2022; 111:779-792. [PMID: 34041784 DOI: 10.1111/apa.15956] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/24/2022]
Abstract
AIM The criteria for diagnosing abusive head trauma (AHT) are not well defined and this condition might be diagnosed on failing premises. Our aim was to review criminal AHT cases in Norwegian courts by scrutinising the underlying medical documentation. METHODS Cases were identified in the data registry for Norwegian courts from 2004 to 2015. Documentation was obtained from relevant health institutions. The medical co-authors first made independent evaluations of the documentation for each child, followed by a consensus evaluation. RESULTS A total of 17 children (11 boys) were identified, all diagnosed as AHT by court appointed experts, 15 were infants (mean age 2.6 months). A high proportion (41.2%) was born to immigrant parents and 31.3% were premature. The medical findings could be explained by alternative diagnoses in 16 of the 17 children; 8 boys (7 infants - mean age 2.9 months) had clinical and radiological characteristics compatible with external hydrocephalus complicated by chronic subdural haematoma. Six children (five infants with mean age 2.1 months) had a female preponderance and findings compatible with hypoxic ischaemic insults. CONCLUSION The medical condition in most children had not necessarily been caused by shaking or direct impact, as was originally concluded by the court experts.
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Affiliation(s)
- Knut Wester
- Department of Clinical Medicine K1 University of Bergen Bergen Norway
| | - Ulf Stridbeck
- Department of Public and International Law Faculty of Law University of Oslo Oslo Norway
| | - Aslak Syse
- Department of Public and International Law Faculty of Law University of Oslo Oslo Norway
| | - Johan Wikström
- Department of Radiology Uppsala University Uppsala Sweden
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Scheller J, Wester K. Is external hydrocephalus a possible differential diagnosis when child abuse is suspected? Acta Neurochir (Wien) 2022; 164:1161-1172. [PMID: 33710381 PMCID: PMC8967805 DOI: 10.1007/s00701-021-04786-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/22/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Criteria for diagnosing abusive head trauma (AHT) or "shaken baby syndrome" are not well defined; consequently, these conditions might be diagnosed on failing premises. METHODS The authors have collected a total of 28 infants, from the US (20) and Norway (8), suspected of having been violently shaken, and their caregivers had been suspected, investigated, prosecuted or convicted of having performed this action. Among 26 symptomatic infants, there were 18 boys (69%) and 8 girls (31%)-mean age 5.1 month, without age difference between genders. RESULTS Twenty-one of 26 symptomatic children (81%) had a head circumference at or above the 90 percentile, and 18 had a head circumference at or above the 97 percentile. After macrocephaly, seizure was the most frequent initial symptom in 13 (50%) of the symptomatic infants. Seventeen (65%) of the symptomatic infants had bilateral retinal haemorrhages, and two had unilateral retinal haemorrhages. All infants had neuroimaging compatible with chronic subdural haematomas/hygromas as well as radiological characteristics compatible with benign external hydrocephalus (BEH). CONCLUSIONS BEH with subdural haematomas/hygromas in infants may sometimes be misdiagnosed as abusive head trauma. Based on the authors' experience and findings of the study, the following measures are suggested to avoid this diagnostic pitfall: medical experts in infant abuse cases should be trained in recognising clinical and radiological BEH features, clinicians with neuro-paediatric experience should always be included in the expert teams and reliable information about the head circumference development from birth should always be available.
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Affiliation(s)
- Joseph Scheller
- Neurologist in Private Practice, 600 Reisterstown Rd #301, Baltimore, MD, 21208, USA
| | - Knut Wester
- Department of Clinical Medicine K1, University of Bergen, N 5021, Bergen, Norway.
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Högberg U. Transfer of knowledge to diagnose infant abuse and its incidence - a time-series analysis from Sweden. Implement Sci 2022; 17:15. [PMID: 35120543 PMCID: PMC8815122 DOI: 10.1186/s13012-022-01188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 12/04/2022] Open
Abstract
Aim To analyse the transfer of knowledge on how to detect physical abuse, especially shaken baby syndrome/abusive head trauma (SBS/AHT), and its association to trends in infant abuse diagnoses (maltreatment and assault). Methods Design: retrospective population-based and quasi-experimental. Setting: Sweden 1987–2019. Patients: Children below age 1 year, selected from the National Patient Register (n = 1150). Exposures: Literature search for transfer of knowledge by diffusion, dissemination and implementation, and whether supportive or disruptive of the SBS/AHT paradigm. Main outcome measure: Abuse diagnoses (maltreatment or assault). Analyses: Incidence rate, incidence rate ratio (IRR). Results The overall incidence rate of abuse was 32.23 per 100,000 during the years 1987–2019. It was rather stable 1987–2000. The SBS diagnosis was introduced in the late 1990s. A comprehensive increase of transfer of knowledge on physical abuse, specifically on SBS/AHT and dangers of shaking, took place from 2002 and onward through diffusion, dissemination and implementation. Maltreatment diagnoses, but not assault diagnosis, increased steeply during 2002–2007, peaking in 2008–2013 [IRR 1.63 (95% confidence interval 1.34–1.98)]. Transfer of disruptive knowledge on SBS/AHT during the period 2014–2019 was associated with a decline in maltreatment diagnoses [IRR 0.84 (95% confidence interval 0.71–0.99)]. Conclusion An increase in maltreatment diagnoses was associated with transfer of supportive knowledge of the SBS/AHT paradigm, while a decline occurred toward the end of the study period, which might indicate a burgeoning de-implementation process. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01188-6.
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Affiliation(s)
- Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden. .,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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12
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Vinchon M, Noulé N, Karnoub MA. The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news. Childs Nerv Syst 2022; 38:133-145. [PMID: 34564748 DOI: 10.1007/s00381-021-05357-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The shaken baby syndrome (SBS) is a common cause of severe traumatic lesions in infants. Although well established for almost five decades, SBS and its diagnosis are becoming more and more aggressively challenged in courts. These challenges feed on the scientific debate and controversies regarding the pathophysiology and the differential diagnoses, scientific uncertainty being readily exploited by specialized barristers. MATERIAL AND METHODS In the present review, we analyze the most common challenges to the concept of SBS and its diagnosis, as well as the scientific evidence available to counter these challenges, the differential diagnoses, and how SBS can be diagnosed with confidence. RESULTS We found that the pathophysiology of SBS is well documented, with stereotyped descriptions by perpetrators, in good correlation with experimental studies and computer models. SBS is a well-defined clinico-pathological entity with a characteristic constellation of lesions; with a rigorous evaluation protocol, its diagnosis can be made rapidly and with excellent accuracy beyond a reasonable doubt. CONCLUSION It is important that medical experts master an extensive knowledge regarding the pathophysiology of the lesions of SBS, in particular infantile subdural hematomas, as well as other CSF-related conditions. This emphasizes the role that pediatric neurosurgeons should play in the clinical and medicolegal management of these patients.
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Affiliation(s)
- Matthieu Vinchon
- Department of Pediatric Neurosurgery, Service de Neurochirurgie Pédiatrique, CHRU de Lille, Lille University Hospital, 59 037, Lille, France.
| | - Nathalie Noulé
- Department of Pediatric Neurosurgery, Service de Neurochirurgie Pédiatrique, CHRU de Lille, Lille University Hospital, 59 037, Lille, France
| | - Melodie-Anne Karnoub
- Department of Pediatric Neurosurgery, Service de Neurochirurgie Pédiatrique, CHRU de Lille, Lille University Hospital, 59 037, Lille, France
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13
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Agreements and disagreements regarding "shaken baby syndrome". Childs Nerv Syst 2022; 38:2047-2049. [PMID: 35945338 PMCID: PMC9617842 DOI: 10.1007/s00381-022-05621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/23/2022] [Indexed: 11/13/2022]
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Watanabe Y, Shiga K, Kikuchi N, Kurihara Y, Sato A. A regional multidisciplinary network enhances child abuse case management. Pediatr Int 2022; 64:e15240. [PMID: 35859263 DOI: 10.1111/ped.15240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/01/2022] [Accepted: 05/12/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND We previously reported an inadequate response to intracranial hemorrhage (ICH) cases under 24 months of age in Yokohama from 2011 to 2013. Hence, it is very important to evaluate how the establishment of a regional multidisciplinary network for child abuse affects the response to ICH cases in medical institutions. METHODS We conducted a questionnaire survey of ICH cases under 24 months of age from 2014 to 2016 using a regional multidisciplinary network for child abuse established in Yokohama in September 2013. We investigated the patients' characteristics, examinations to identify inflicted injury, and reports made to the hospital-based child protection team (CPT) or regional child protective service (CPS), and compared the results of a previous study and the current study, which corresponds to before and after the establishment of the regional network, respectively. RESULTS The total number of ICH cases was 50 in 3 years. The number of cases surveyed for covert fracture and fundus hemorrhage increased significantly after the establishment of the regional network (P = 0.0001 and P = 0.0182, respectively). The number of cases reported as suspected child abuse was 41 (82%) to the hospital-based CPTs and 27 (54%) to the regional CPSs. There were significant differences between before and after the establishment of the regional network regarding CPT (P = 0.0062) and CPS (P = 0.0215) reports. CONCLUSIONS A regional multidisciplinary network can enhance response and cooperation to address child abuse. It deepens our understanding of such care and improves awareness by hospital personnel of child abuse.
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Affiliation(s)
- Yoshihiro Watanabe
- Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Japan.,Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kentaro Shiga
- Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Japan.,Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Nobuyuki Kikuchi
- Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Japan.,Department of Pediatrics, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Yachiyo Kurihara
- Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Japan.,Department of Pediatrics, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
| | - Atsuo Sato
- Yokohama Medical Network for Maltreated Children, Child and Youth Bureau, Yokohama Municipal Government, Yokohama, Japan.,Department of Pediatrics, Yokohama Rosai Hospital, Yokohama, Japan
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Kehinde F, Marinescu A, Turchi R. Catch it before it breaks!: managing metabolic bone disease of prematurity. Curr Opin Pediatr 2021; 33:676-683. [PMID: 34734916 DOI: 10.1097/mop.0000000000001060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Metabolic bone disease of prematurity, commonly referred to as osteopenia of prematurity, remains prevalent in the neonatal intensive care unit (NICU) despite recent medical advances. It is estimated that up to 60% of extreme low birth weight and 20% of very low-birth-weight infants have metabolic bone disease of prematurity. Often silent, it typically presents with poor growth, increased ventilator dependency and fractures. Clinical sequalae, such as short stature can extend into young adulthood. There is no universal consensus by neonatal intensive care unit clinicians on the screening, diagnosis, or treatment for metabolic bone disease of prematurity. The disease is often diagnosed late by radiographs or incidentally in this highly fragile population. RECENT FINDINGS Suggest screening using DEXA (dual-energy X-ray absorptiometry) scans or ultrasound, in combination with serum markers like alkaline phosphatase, phosphorous levels, parathyroid hormone, and tubular reabsorption of phosphate, might identify at-risk babies earlier. The use of protocol-based screenings may aid in early diagnosis. SUMMARY We present a review of the risk factors, recent screening methods, diagnosis and management of this prevalent, clinically relevant diagnosis, as well as propose a protocol for the early screening and management of this silent disease.
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Affiliation(s)
- Folasade Kehinde
- Division of Neonatology.,Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Renee Turchi
- Department of Pediatrics, St. Christopher's Hospital for Children.,Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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