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

23 Citations (Scopus)

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 (US)
Pages (from-to)1048-1065
Number of pages18
JournalPediatric Radiology
Volume48
Issue number8
DOIs
StatePublished - Aug 1 2018

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Craniocerebral Trauma
Wounds and Injuries
Intracranial Subdural Hematoma
Spinal Subdural Hematoma
Parturition
Rib Fractures
Retinal Hemorrhage
Intracranial Thrombosis
Subdural Hematoma
Spinal Puncture
Homicide
Airway Obstruction
Physical Examination
Vomiting
History

All Science Journal Classification (ASJC) codes

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

Cite this

Choudhary, A. K., Servaes, S., Slovis, T. L., Palusci, V. J., Hedlund, G. L., Narang, S. K., ... 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
Choudhary, Arabinda Kumar ; Servaes, Sabah ; Slovis, Thomas L. ; Palusci, Vincent J. ; Hedlund, Gary L. ; Narang, Sandeep K. ; Moreno, Joëlle Anne ; Dias, Mark S. ; Christian, Cindy W. ; Nelson, Marvin D. ; Silvera, V. Michelle ; Palasis, Susan ; Raissaki, Maria ; Rossi, Andrea ; Offiah, Amaka C. / Consensus statement on abusive head trauma in infants and young children. In: Pediatric Radiology. 2018 ; Vol. 48, No. 8. pp. 1048-1065.
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Choudhary, AK, Servaes, S, Slovis, TL, Palusci, VJ, Hedlund, GL, Narang, SK, Moreno, JA, Dias, MS, Christian, CW, Nelson, MD, Silvera, VM, Palasis, S, Raissaki, M, Rossi, A & Offiah, AC 2018, 'Consensus statement on abusive head trauma in infants and young children', Pediatric Radiology, vol. 48, no. 8, pp. 1048-1065. https://doi.org/10.1007/s00247-018-4149-1

Consensus statement on abusive head trauma in infants and young children. / Choudhary, Arabinda Kumar; Servaes, Sabah; Slovis, Thomas L.; Palusci, Vincent J.; Hedlund, Gary L.; Narang, Sandeep K.; Moreno, Joëlle Anne; Dias, Mark S.; Christian, Cindy W.; Nelson, Marvin D.; Silvera, V. Michelle; Palasis, Susan; Raissaki, Maria; Rossi, Andrea; Offiah, Amaka C.

In: Pediatric Radiology, Vol. 48, No. 8, 01.08.2018, p. 1048-1065.

Research output: Contribution to journalReview article

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AU - Choudhary, Arabinda Kumar

AU - Servaes, Sabah

AU - Slovis, Thomas L.

AU - Palusci, Vincent J.

AU - Hedlund, Gary L.

AU - Narang, Sandeep K.

AU - Moreno, Joëlle Anne

AU - Dias, Mark S.

AU - Christian, Cindy W.

AU - Nelson, Marvin D.

AU - Silvera, V. Michelle

AU - Palasis, Susan

AU - Raissaki, Maria

AU - Rossi, Andrea

AU - Offiah, Amaka C.

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N2 - 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.

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Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK et al. Consensus statement on abusive head trauma in infants and young children. Pediatric Radiology. 2018 Aug 1;48(8):1048-1065. https://doi.org/10.1007/s00247-018-4149-1