A public hearing. “Shaken baby syndrome: Guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff”. Scoping report

Laurent-Vannier, A.; Nathanson, M; Quiriau, F; Briand-Huchet, E.; Cook, Jo-Ann; Villemeur, T Billette de; Chazal, J.; Christophe, Catherine; Defoort‐Dhellemmes, Sabine; Fortin, Gilles; Rambaud, Caroline; Raul, Jean‐Sébastien; Rey-Salmon, Caroline; Sottet, F; Vieux, E; Vinchon, Matthieu; Willinger, Rémy

doi:10.1016/j.rehab.2011.10.003

Cited by 28 publications

(13 citation statements)

References 145 publications

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“…Our series also showed the classic demographic data [2]. The male-to-female ratio was 2:14 (45 boys, 21 girls).…”

Section: Introductionsupporting

confidence: 71%

“…4). We should also emphasize that there are no consistent data in the literature to support the hypothesis that benign enlargement of subarachnoid spaces predisposes infants to subdural hematomas [1,2,19]. Conversely and importantly, sulcal expansion may be a consequence of abusive head trauma, in the context of brain atrophy and/or impaired cerebrospinal fluid resorption (Fig.…”

Section: Dating Based On Imaging Is Inaccuratementioning

confidence: 97%

“…In particular, it is important to remember that a pattern of heterogeneous or multilayered densities within the subdural hematoma does not necessarily imply repeated injury, since there is ample documentation that subdural hematomas may rebleed spontaneously due to the presence of inflammatory membranes with newly formed capillaries (Fig. 3) [1,2,11]. In addition, subdural hematomas in the posterior fossa and interhemispheric fissure only become evident -i.e.…”

Section: Dating Based On Imaging Is Inaccuratementioning

confidence: 99%

“…The hemosiderin deposits (low signal at T2-weighted gradient echo) can last months or even years. Several papers have, however, pointed out the lack of evidence in dating subdural collections [1,2,[7][8][9]11]. Of interest is that membranes within subdural hematoma begin to form after 2 weeks and may be exquisitely demonstrated with MRI [12].…”

Section: Dating Based On Imaging Is Inaccuratementioning

confidence: 99%

“…Diffuse subdural hematoma with no evidence of accident is a key diagnostic marker thought to be related to the tearing of the cerebral bridging veins due to violent shaking [1,2]. Hypoxic-ischemic injuries are known to be frequently associated to the subdural hematoma and responsible for the outcome of the injured child [1,2]. Dating the incident, however, remains very controversial as perpetrators rarely admit their actions.…”

Section: Introductionmentioning

confidence: 99%

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Dating the abusive head trauma episode and perpetrator statements: key points for imaging

et al. 2014

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Shaken baby syndrome/abusive head trauma is a leading cause of morbidity and mortality in infants. The presence of a diffuse subdural hematoma without evidence of accident is a key diagnostic clue. The hematoma is typically attributed to rupture of the cerebral bridging veins due to violent shaking, with or without impact. Dating the incident, however, remains controversial. The aim of this article is to review the most reliable features used for dating the incident, based on both legal statements by perpetrators and medical documentation. The key points are: 1) The high (yet likely underestimated) frequency of repeated shaking is around 50%, 2) Children do not behave normally immediately after shaking, and the time of onset of even mild symptoms appears to be the best clue for dating the incident and 3) Brain imaging provides strong indicators of "age-different" injuries but the ranges for dating the causal event are wide. The density pattern in a single subdural hematoma location provides no reliable clues for assessing repeated violence. Only the finding of different density in two distant subdural hematomas argues in favor of "age-different" injuries, i.e. repeated violence. MRI is difficult to interpret in terms of dating subdural hemorrhages and must be analyzed in conjunction with CT. Most importantly, all of the child's previous clinical and radiological data must be carefully studied and correlated to provide accurate information on the date and repetition of the trauma.

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“…Our series also showed the classic demographic data [2]. The male-to-female ratio was 2:14 (45 boys, 21 girls).…”

Section: Introductionsupporting

confidence: 71%

Section: Dating Based On Imaging Is Inaccuratementioning

confidence: 97%

Section: Dating Based On Imaging Is Inaccuratementioning

confidence: 99%

Section: Dating Based On Imaging Is Inaccuratementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dating the abusive head trauma episode and perpetrator statements: key points for imaging

et al. 2014

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High Frequency of Previous Abuse and Missed Diagnoses Prior to Abusive Head Trauma: A Consecutive Case Series of 100 Forensic Examinations

2020

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This study describes the frequency of signs and symptoms of abuse and missed diagnoses prior to the diagnosis of abusive head trauma (AHT) in infants. Data were from a retrospective observational study of 100 consecutive cases of infants diagnosed with AHT over a seven‐year period. The most frequent symptom leading to the diagnosis was a loss of consciousness (68%) that always occurred inside a home (parents' or nanny's), never outside. Diagnosis was established using criteria based on the child's lesions and the alleged history. Lesions leading to diagnosis were described: 99 per cent had multifocal subdural haematoma (SDH) located in four areas including lateral space, interhemispheric, tentorium cerebelli and vertex; 60 per cent had a rupture of bridging veins. Previous abuse was found in 79 per cent of cases, of whom 75 per cent underwent medical consultations that did not result in a diagnosis of abuse. The main signs and symptoms of previous abuse were repeated vomiting without fever or diarrhoea (62%), abnormal head circumference increase (49%) and bruises (38%). These results suggest a higher frequency of repeated abuse than previous studies and highlight the great challenges most professionals encounter to evoke and set the diagnosis of abuse.‘This study describes the frequency of signs and symptoms of abuse and missed diagnoses prior to the diagnosis of abusive head trauma (AHT) in infants’Key Practitioner Messages Prior signs and symptoms suggestive of abuse are particularly frequent in infants diagnosed with AHT. Abuse must be detected as early as possible in order to avoid recurrences. Diagnostic criteria, based on clinical history and lesions including multifocal subdural haematoma, rupture of bridging veins, retinal haemorrhages, and spinal cord injury have been defined to enable diagnosis of AHT.

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Abusive Head Trauma through Shaking: Examination of the Perpetrators According to Dating of the Traumatic Event

2021

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Effective prevention of abusive head trauma (AHT) requires the identification of potential perpetrators. Current evidence suggests that infant shaking, as a mechanism of AHT, produces immediate symptoms, allowing for the dating of the event based on clinical symptoms. Determining precisely when symptoms occurred may help law enforcement to identify the perpetrator. We retrieved written legal statements and medical records from birth to age at diagnosis of 100 infants consecutively diagnosed with AHT through shaking (2011-17), using forensic expertise files. Timing of abuse allowed for the identification of perpetrators in 91 cases. All abusive events occurred inside a home (parent's or nanny's), never outdoors or in a public place, and always in the presence of only one adult. Approximately one-third (n = 32) of the perpetrators were males (31 fathers) and two-thirds (n = 59) were females: 49 of them were the infant's nanny and ten were the infant's mother. Infants were not described as crying habitually. Better knowledge of the context of AHT events and risk situations, including recent implementation of a new or unusual modality of childcare, and being the only adult in a home with an infant, should facilitate prevention, including targeted training and avoidance of situations associated with risk.

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A public hearing. “Shaken baby syndrome: Guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff”. Scoping report

Cited by 28 publications

References 145 publications

Dating the abusive head trauma episode and perpetrator statements: key points for imaging

Dating the abusive head trauma episode and perpetrator statements: key points for imaging

High Frequency of Previous Abuse and Missed Diagnoses Prior to Abusive Head Trauma: A Consecutive Case Series of 100 Forensic Examinations

Abusive Head Trauma through Shaking: Examination of the Perpetrators According to Dating of the Traumatic Event

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