Abusive head trauma in court: a multi-center study on criminal proceedings in Germany

Abstract

The shaken baby syndrome (SBS) is a common variant of abusive head trauma (AHT) in infants and toddlers. Data on the legal outcome of such cases are still sparse. By means of a retrospective multi-center analysis, 72 cases of living children diagnosed with SBS/AHT from three German university institutes of legal medicine were identified. Forty-six of these cases with 68 accused individuals were available and could be evaluated with regard to basic data on the course of the criminal proceedings as well as the profile of the defendants (sub-divided into suspects, convicts, and confessed perpetrators). Criminal proceedings predominantly commenced with a complaint by the treating hospital (62%) and were found to be closed (without judgment) in 50% of the cases, mostly due to a “lack of sufficient suspicion.” Of the 23 cases with judgment, the court decided on acquittal in 4 cases (17%). Imprisonment was the most frequent sentence (16 out of 19 cases with conviction, 84%), whereby the sentence has been suspended on probation in 63% of the cases. Suspects and perpetrators were mostly male and derived from the close family environment of the injured children. All confessed perpetrators stated an “excessive demand” as the reason for the violent shaking of the child. The results of the present study are in line with data from other studies with other legal systems. As many criminal proceedings were closed and the 4 acquittals occurred because the perpetration could not be ascribed to a specific perpetrator, improving the forensic methods for such an unequivocal assignment would be desirable.

Is external hydrocephalus a possible differential diagnosis when child abuse is suspected?

“…Usually, conviction for child abuse requires supporting evidence. A recent German survey of 68 accused cases revealed conviction for child abuse in 19; 15 of which included confessions by the alleged perpetrators, but four without [16]. Still, recent surveys and court cases show that the triad may be accepted as an unequivocal sign of child abuse and lead to conviction without a confession or supporting evidence [65].…”

Fractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study

“…The strength of the study is that confessions by perpetrators could be used for validation. The confessions of the present study were previously disclosed [ 28 ]. Thus, the danger of circular reasoning, which otherwise can be a limitation in AHT studies, could be reduced by comparison of 15 cases with and 57 cases without confession by perpetrators.…”

“…However, such data are very rare and did not occur in cases of the present study. Frequently, the perpetrator belongs to the close family environment [ 28 ] and is often alone with the child during the act of maltreatment. Furthermore, the young victims are mostly incapable of reporting on incidents themselves.…”

“…Based on a previous analysis of the associated criminal proceedings [ 28 ], the total study cohort was subsequently subdivided into “non-confession cases” (cases without confessed perpetrators) and “confession cases” (cases with confessed perpetrators). Thereby, homogeneity of the whole study group can be demonstrated independent of a confession, which strongly supports a correct diagnosis also in the non-confession cases and thus reducing circular reasoning.…”

Pediatric Abusive Head Trauma: A Systematic Review

“…The aim of our study was to evaluate the best diagnostic protocol by reviewing the literature and providing a case in which this protocol was correctly applied, to reduce the rate of misdiagnosed or criminal cases that end without a verdict, due to "lack of sufficient suspicion", as shown by Feld et al [53].…”