Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data

Brook, Chris

doi:10.1016/j.fsisyn.2023.100314

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…The statistical similarities presented in Table 1 between the categories of witnessed accidents and reported accidents have also been documented and have recently been interpreted as corroborating evidence that caregivers are generally telling the truth when they report a traumatic accident 19 …”

Section: Discussionsupporting

confidence: 53%

“…3 However, the evidentiary association between these clinical findings and traumatic shaking has been criticized for its heavy reliance on circular reasoning and/or admissions made during the investigative or judicial process. [4][5][6][7][8][9][10] Neither diagnoses nor admissions made during the investigative or judicial process make reliable scientific reference standards to robustly categorize cases as AHT. These weaknesses in methodology have made some researchers question the validity and accuracy of the manner in which such clinical findings are used to diagnose AHT.…”

Section: Introductionmentioning

confidence: 99%

“…However, the evidentiary association between these clinical findings and traumatic shaking has been criticized for its heavy reliance on circular reasoning and/or admissions made during the investigative or judicial process 4–10 . Neither diagnoses nor admissions made during the investigative or judicial process make reliable scientific reference standards to robustly categorize cases as AHT.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…One can instead adopt unbiased, independently witnessed events as a reference standard to classify cases as AHT versus non‐AHT. With this reference standard, cases diagnosed as AHT but witnessed to be accidents become false positive cases 11 . In other words, the five cases of witnessed accidents diagnosed as AHT are considered to be misdiagnoses when analysis is done with noncircular methodology.…”

Section: Discussionmentioning

confidence: 99%

“…With this reference standard, cases diagnosed as AHT but witnessed to be accidents become false positive cases. 11 In other words, the five cases of witnessed accidents diagnosed as AHT are considered to be misdiagnoses when analysis is done with noncircular methodology. Using this more scientifically rigorous approach, the implied rates of misdiagnosis of reported accidents would be even higher, possibly much higher, with no upper limit on how many of the diagnoses were false.…”

Section: Implied Rates Of Misdiagnosis Of Accidents As Ahtmentioning

confidence: 99%

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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Impact of the COVID-19 Pandemic On Violence Against Children: A Narrative Review

Mojahed,

Mack,

Specht

et al. 2023

Curr Psychiatry Rep

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Purpose of Review The goal of this paper was to explore the different ways the COVID-19 pandemic has affected violence against children (VAC). Recent Findings Recent research of peer-reviewed articles using operational or survey data revealed the pandemic’s impact in terms of institutional responses, risk and mediating factors, changes in VAC dynamics, and a likely increase in child marriage. Summary Findings include a decrease in institutional responses, activities, and prevention case openings; an increased incidence of interparental intimate partner violence (IPV) witnessing cases, hospital admissions for suspected Abusive Head Trauma (AHT), other pediatric injuries, and sexual violence; a change in family conflict dynamics; and an estimated increase in child marriages. It also revealed mediating factors between the relationship of the pandemic and VAC (such as parental stress and mental health symptoms), as well as risk factors observed by service providers, which include the risk of mental health symptoms of both parents and children. Post-pandemic VAC research can be improved by utilizing operational or survey data in a meaningful way to be able to derive sound intervention approaches to diminish the pandemic’s impact on VAC and child marriage. We also propose for researchers to integrate child marriage into the definition of VAC.

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Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data

Cited by 3 publications

References 21 publications

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

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

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

Impact of the COVID-19 Pandemic On Violence Against Children: A Narrative Review

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