Consensus statement on abusive head trauma in infants and young children

Arabinda Kumar Choudhary, Sabah Servaes, Thomas L. Slovis, Vincent J. Palusci, Gary L. Hedlund, Sandeep K. Narang, Joëlle Anne Moreno, Mark S. Dias, Cindy W. Christian, Marvin D. Nelson, V. Michelle Silvera, Susan Palasis, Maria Raissaki, Andrea Rossi, Amaka C. Offiah

Research output: Contribution to journalReview article

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.

Original languageEnglish
Pages (from-to)1048-1065
Number of pages18
JournalPediatric Radiology
Volume48
Issue number8
DOIs
Publication statusPublished - Aug 1 2018

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging

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  • Cite this

    Choudhary, A. K., Servaes, S., Slovis, T. L., Palusci, V. J., Hedlund, G. L., Narang, S. K., Moreno, J. A., Dias, M. S., Christian, C. W., Nelson, M. D., Silvera, V. M., Palasis, S., Raissaki, M., Rossi, A., & Offiah, A. C. (2018). Consensus statement on abusive head trauma in infants and young children. Pediatric Radiology, 48(8), 1048-1065. https://doi.org/10.1007/s00247-018-4149-1