Estimating the Relevance of Historical Red Flags in the Diagnosis of Abusive Head Trauma

Hymel, Kent P.; Lee, Gloria S.; Boos, Stephen C.; Karst, Wouter A.; Sirotnak, Andrew; Haney, Suzanne B.; Laskey, Antoinette L.; Wang, Ming

doi:10.1016/j.jpeds.2019.11.010

Cited by 15 publications

(15 citation statements)

References 17 publications

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“…Provided these five unspoken auxiliary hypotheses are valid, it might be possible to claim that infants with the isolated triad must have been shaken violently (Hymel, 2020;Duhaime, 1992). The next step is to assess the caregiver's account of events.…”

Section: Cpt=child Protection Teammentioning

confidence: 99%

“…If the caregiver instead states that he/she actually shook the baby, but only in an attempt at resuscitation after it became unconscious, then the caregiver has changed the account of events. The CAP concludes that this story is "not acceptable" for two reasons: (i) the assumed cause cannot appear after its effects, i.e., after the encephalopathy symptoms; (ii) the fact that the caregiver changed the narrative is suspicious in itself (Hettler & Greenes, 2003;Hymel et al, 2020). "No history" or "changing the initial history" has actually been used as a positive predictive value for diagnosing AHT (Hettler & Greenes, 2003;Hymel et al, 2020).…”

Section: Cpt=child Protection Teammentioning

confidence: 99%

“…But an assessment of the caregiver's account of events is also often included. A typical question is whether the (initial) narrative is commensurate with the alleged signs of trauma (Hettler & Greenes, 2003;Hymel et al, 2020). If a caregiver states that nothing has happened and the infant in addition to the triad exhibits a number of external signs of trauma-e.g., bruises, fractures-these signs might indicate that the caregiver is hiding something and not telling the truth.…”

Section: Introductionmentioning

confidence: 99%

“…But how is it possible to conclude that a child without accepted signs of trauma has been physically abused? Research has been undertaken in order to provide CAPs and Child Protection Teams (CPTs) with guidelines for the diagnosis of AHT (Hettler & Greenes, 2003;Hymel et al, 2020;Duhaime et al, 1992;Chadwick, 1997;Reece & Sege, 2000;Reece, 2008;De Leeuw et al, 2013). Algorithms and criteria have been developed and a special clinical tool, for predicting AHT, has also been presented (Cowley et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…This algorithm has obviously had a huge impact on how concerned CAPs and child protection teams have diagnosed AHT, and was also used by Reece et al when evaluating criteria for diagnosing AHT (Reece & Sege, 2000;Reece, 2008). The same algorithm was applied by Hettler et al (Hettler & Greenes, 2003) and recently by Hymel et al (Hymel et al, 2020) to estimate the validity of the caregiver's initial story in predicting shaking. Furthermore, the presence or lack of a lucid interval was used when de Leeuw et al (De Leeuw et al, 2013) determined whether or not the caregiver's story was 53 www.scholink.org/ojs/index.php/jrph Journal of Research in Philosophy and History Vol.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Cpt=child Protection Teammentioning

confidence: 99%

Section: Cpt=child Protection Teammentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Data‐driven evidence shows truthful caregiver histories and significant overdiagnosis of abusive head trauma

Brook

2023

Annals of the Child Neurology Society

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ObjectiveWe analyzed the veracity of caregiver‐provided histories when infants present with intracranial pathologies and abusive head trauma (AHT) is suspected.MethodsA comparison of medical findings is made using data from 335 infants with acute intracranial pathologies and no extracranial findings associated with abuse. Two null hypotheses were tested: (1) that cases where caregivers reported accidental trauma have similar medical findings to independently witnessed accidents; and (2) that cases where caregivers reported no trauma have similar medical findings as cases where caregivers reported accidental trauma.ResultsThe first null hypothesis is not rejected, corroborating caregiver histories of accidental trauma, yet such cases are diagnosed as AHT at significantly higher rates than accidents witnessed by unbiased independent observers. The second null hypothesis is rejected, corroborating caregiver histories that no trauma occurred.ConclusionsData suggest that caregivers can provide valuable diagnostic information when infants present with acute intracranial pathologies and suggest substantial rates of misdiagnosis of AHT.

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Retino‐dural hemorrhages in infants are markers of degree of intracranial pathology, not of violent shaking

Brook

2024

Annals of the Child Neurology Society

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AimThis study analyzed whether retino‐dural hemorrhages in infants are markers of the degree of intracranial pathology, rather than evidence of violent shaking.MethodsUsing data from 420 infants with acute intracranial pathologies, comparison of clinical findings is made between cases diagnosed as abusive head trauma (AHT) and four categories: cases where caregivers report no trauma; cases of witnessed or admitted AHT; cases where caregivers report accidental trauma; and witnessed accidents. The data are then controlled for degree of intracranial pathology by only comparing cases in each category that have evidence of hypoxic‐ischemic swelling.ResultsAlthough categories differ in clinical findings when all data are considered, they do not differ when the data are controlled for degree of intracranial pathology.ConclusionsThe data suggest that the clinical findings widely considered to be indicative of shaking are instead markers of the degree of intracranial pathology. Previous results showing differences were driven by selection effects, whereby different categories have different fractions of serious cases. Most notably, caregiver and witnessed reports of accidental head trauma led doctors to explore intracranial pathologies across a broader spectrum of severity, including milder cases, as opposed to situations where no head trauma is reported.

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Estimating the Relevance of Historical Red Flags in the Diagnosis of Abusive Head Trauma

Cited by 15 publications

References 17 publications

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

Data‐driven evidence shows truthful caregiver histories and significant overdiagnosis of abusive head trauma

Retino‐dural hemorrhages in infants are markers of degree of intracranial pathology, not of violent shaking

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