Re‐evaluation of abusive head trauma in Norway appears flawed

Benign enlargement of the subarachnoid spaces and subdural collections—when to evaluate for abuse

“…In infants with macrocephaly and subdural collections, the possibility of abusive injury may be supported by the presence of concomitant suspicious injuries in various organs and sites: co-existing parenchymal injuries or cytotoxic oedema, bridging vein thrombosis/rupture, subdural collections in different locations (around right frontal lobe, around left frontal lobe, convexity, interhemispheric fissure, posterior fossa), spinal injuries (including ligamentous injuries and subdural spinal haematomas), unexplained fractures, especially classic metaphyseal lesions (CMLs), rib and skull fractures [23,[29][30][31][32][53][54][55][56][57][58][59][60][61][62]. Skin, oral and genital stigmata are extremely important to identify, strongly supporting the hypothesis of abuse in the absence of any additional finding in a child with BESS and subdural collection(s) [63][64][65]. A relevant social history disclosing factors and conditions that might place a child at risk for maltreatment and a previous history of unexplained or frequent trauma to the same patient or household members, a delay in seeking help and a changing history are also red flags for physical abuse [10,64].…”

“…Skin, oral and genital stigmata are extremely important to identify, strongly supporting the hypothesis of abuse in the absence of any additional finding in a child with BESS and subdural collection(s) [ 63 – 65 ]. A relevant social history disclosing factors and conditions that might place a child at risk for maltreatment and a previous history of unexplained or frequent trauma to the same patient or household members, a delay in seeking help and a changing history are also red flags for physical abuse [ 10 , 64 ]. Apnoea, loss of consciousness, and death, to our knowledge, have not been described in infants with BESS, as opposed to infants with abusive head trauma [ 10 , 35 , 53 ].…”

Corrigendum to the paper ‘Re‐evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses’

“…Stray‐Pedersen et al 2 have claimed that we made other errors. We can explain these by stating, as is also described in the article, that we did not have access to all the data at the time of the retrospective analysis.…”

“…They argued that the medical conditions had not necessarily been caused by shaking or direct impact. Stray‐Pedersen et al claim that the re‐evaluation by Wester et al appears to be flawed 2 . Wester et al respond to their comments and made a corrigendum of their original article 3 .…”