Alternate theories of causation in abusive head trauma: What the science tells us

Jenny, Carole

doi:10.1007/s00247-014-3106-x

Cited by 20 publications

(11 citation statements)

References 53 publications

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“…The supposedly tell-tale symptoms of shaken baby syndrome-subdural hematoma, retinal bleeding, and brain swelling-can stem from a variety of other causes, including, for instance, sudden infant death syndrome, venous sinus thrombosis (see Zakirova, 2017), and external hydrocephalus (Wester, 2019). As a result, medical and legal experts are increasingly likely to dispute the appropriateness of a shaken baby syndrome diagnosis (see, e.g., Findley et al, 2012;Jenny, 2014;Lynøe et al, 2017). Indeed, 11% of the 2,000 shaken baby syndrome cases that went to criminal court between 2001 and 2015 were either dropped, dismissed, or resulted in overturned convictions because secondary analyses showed other causes of death (Cenzipper, 2015).…”

Section: Race and Medical Misdiagnosis Of Abusementioning

confidence: 99%

Do Racial Stereotypes Contribute to Medical Misdiagnosis of Child Abuse?

Najdowski

Bernstein

Wahrer

2020

wclawr

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Despite growing recognition that misdiagnoses of child abuse can lead to wrongful convictions, little empirical work has examined how the medical community may contribute to these errors. Previous research has documented the existence and content of stereotypes that associate race with child abuse. The current study examines whether emergency medical professionals rely on this stereotype to fill in gaps in ambiguous cases involving Black children, thereby increasing the potential for misdiagnoses of child abuse. Specifically, we tested whether the race-abuse stereotype led participants to attend to more abuse-related details than infection-related details when an infant patient was Black versus White. We also tested whether this heuristic decision-making would be affected by contextual case facts; specifically, we examined whether race bias would be exacerbated or mitigated by a family’s involvement with child protective services (CPS). Results showed that participants did exhibit some biased information processing in response to the experimental manipulations. Even so, the race-abuse stereotype and heuristic decision-making did not cause participants to diagnose a Black infant patient with abuse more often than a White infant patient, regardless of his family’s involvement with CPS. These findings help illuminate how race may lead to different outcomes in cases of potential child abuse, while also demonstrating potential pathways through which racial disparities in misdiagnosis of abuse and subsequent wrongful convictions can be prevented.

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Section: Race and Medical Misdiagnosis Of Abusementioning

confidence: 99%

Do Racial Stereotypes Contribute to Medical Misdiagnosis of Child Abuse?

Najdowski

Bernstein

Wahrer

2020

wclawr

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“…But conditions which refer to re-bleeds after a birth related SDH, brain swelling due to hypoxia, venous sinus thrombosis, benign extra-axial fluid of infancy and minor trauma are not "acceptable" differential diagnoses (Jenny, 2014).…”

Section: Cpt=child Protection Teammentioning

confidence: 99%

“…Although Geddes' hypoxia theory has been heavily criticized by proponents of the traditional AHT mechanism theories (Choudhary et al, 2018, Jenny, 2014Punt et al, 2004;Richards et al, 2006), authors of a comparison analysis found the hypoxia theory was much more plausible than the traditional AHT mechanism theories (Acres & Morris, 2014). Moreover, other authors have actually corroborated Geddes' hypoxia theory (Kemp et al, 2003;Oehmichen, Schleiss, Pedal, Saternus, Gerling, Meissner, 2008;Cohen & Scheimberg, 2009;Cohen, Sprigg, Whitby, 2010;Scheimberg et al, 2013).…”

Section: Are the Mechanism Theories And The Associated Auxiliary Hypomentioning

confidence: 99%

The Unspoken Shaken Baby Lie Detector Algorithm—An Analysis of Diagnostic Procedures in Cases of Allegedly Abusive Head Trauma without External Signs of Trauma

Lynøe¹,

Eriksson²

2020

JRPH

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Various algorithms have been developed for diagnosis of Abusive Head Trauma (AHT); however, there is no explicit algorithm for the 1/3 of alleged AHT cases which present with findings restricted to subdural and retinal hemorrhages, with or without encephalopathy—i.e., isolated triad cases. Moreover, such cases have been lumped together with AHT cases with external sign of trauma and all diagnosed as AHT despite those we are focusing on lack signs of trauma. It is therefore relevant to analyze how this diagnosis can be reached in the absence of unequivocal trauma. Our analysis indicates that with respect to isolated triad cases, a two-step algorithm seems to be in use—but unspoken. The first step concerns a ruling out diagnostic process and the second step addresses the veracity of the caregivers’ narrative. Both steps are based on the traditional AHT mechanism theories and ten tacitly applied auxiliary hypotheses which are, however, questionable or incorrect. If the traditional AHT mechanism theories and necessary auxiliary hypotheses are not valid, then neither is the two-step algorithm. Accordingly, we propose that in alleged AHT cases with no external signs of trauma, the two-step algorithm—here referred to as the unspoken shaken baby lie detector algorithm—should be abandoned.

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“…33 When attempting to determine the cause of an SDH, care must be taken to differentiate legitimate medical diagnoses from pseudoscience and to only make associations seen during the normal course of medical practice. 34 For instance, purely hypoxic events as evidenced by victims of asphyxia, suffocation, and drowning do not have radiologically apparent SDH. 35 Hypoxia would therefore not be a plausible reason for radiologically apparent SDH in a child being evaluated for AHT.…”

Section: Extra-axial Hemorrhagesmentioning

confidence: 99%

The Role of Neuroimaging in the Evaluation of Abusive Head Trauma

Hinds

Shalaby‐Rana

2016

J Pediatr Neuroradiol

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Neuroimaging is an integral part of the work-up for children who may have experienced abusive head trauma (AHT). The initial exam is usually a head computed tomography (CT), which may be followed by magnetic resonance imaging (MRI) of the brain and/or spine, depending on clinical presentation and/or findings on head CT. Neuroimaging is important for both clinical care and prognosis, as well as the process of distinguishing AHT from accidental trauma. Brain CT and conventional MRI may provide evidence of more than one traumatic event. Diffusion-weighted and susceptibility-weighted imaging help with both acute clinical interventions and prognostication about neurodevelopmental outcomes. With more widespread use of spinal MRI, there is increased appreciation of the spectrum of clinically occult spinal soft tissue injuries associated with AHT. This review highlights clinical and radiologic findings in children evaluated for AHT and emphasizes the importance of a multidisciplinary evaluation.

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Alternate theories of causation in abusive head trauma: What the science tells us

Abstract: When cases of suspected abusive head trauma are adjudicated in courts of law, several alternative theories of causation are frequently presented. This paper reviews common theories and examines their scientific basis.

Cited by 20 publications

References 53 publications

Do Racial Stereotypes Contribute to Medical Misdiagnosis of Child Abuse?

Do Racial Stereotypes Contribute to Medical Misdiagnosis of Child Abuse?

The Unspoken Shaken Baby Lie Detector Algorithm—An Analysis of Diagnostic Procedures in Cases of Allegedly Abusive Head Trauma without External Signs of Trauma

The Role of Neuroimaging in the Evaluation of Abusive Head Trauma

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