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Consensus statement on abusive head trauma in infants and young children

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Abstract

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic–ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.

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Acknowledgments

We are grateful to the fellows at Children’s Hospital of Philadelphia who reviewed the references for this manuscript (Andrew J. Degnan, Rachelle Durand, Edward Fenlon, Ami Gokli, Aditi Hendi, James Hogan, Fang Lu, Ian Mills, Christy Pomeranz, Jordan Rapp and Michele Retrouvey).

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Authors and Affiliations

  1. Department of Radiology, Nemours AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Arabinda Kumar Choudhary

  2. Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA

    Sabah Servaes

  3. Department of Radiology, Children’s Hospital of Michigan, Wayne State University, Detroit, MI, USA

    Thomas L. Slovis

  4. New York University School of Medicine, New York, NY, USA

    Vincent J. Palusci

  5. Department of Medical Imaging, Primary Children’s Hospital, Intermountain Healthcare, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Gary L. Hedlund

  6. Division of Child Abuse Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Sandeep K. Narang

  7. Florida International University College of Law, Miami, FL, USA

    Joëlle Anne Moreno

  8. Departments of Neurosurgery and Pediatrics, Penn State Health Children’s Hospital, Hershey, PA, USA

    Mark S. Dias

  9. Department of Pediatrics, Child Abuse and Neglect Prevention, The Children’s Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Cindy W. Christian

  10. Department of Radiology, Children’s Hospital of Los Angeles, Los Angeles, CA, USA

    Marvin D. Nelson Jr

  11. Department of Radiology, Boston Children’s Hospital, Boston, MA, USA

    V. Michelle Silvera

  12. Pediatric Neuroradiology, Children’s Healthcare of Atlanta, Scottish Rite Campus, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA

    Susan Palasis

  13. Department of Radiology, University Hospital of Heraklion, University of Crete, Crete, Greece

    Maria Raissaki

  14. Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy

    Andrea Rossi

  15. Paediatric Musculoskeletal Imaging, Academic Unit of Child Health, Sheffield Children’s NHS Foundation Trust, Western Bank, University of Sheffield, Sheffield, UK

    Amaka C. Offiah

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  1. Arabinda Kumar Choudhary
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  2. Sabah Servaes
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  3. Thomas L. Slovis
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  5. Gary L. Hedlund
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  8. Mark S. Dias
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  9. Cindy W. Christian
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Corresponding author

Correspondence to Arabinda Kumar Choudhary.

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Conflicts of interest

Dr. Narang has been paid as an expert consultant/witness in cases of abusive head trauma. Drs. Choudhary, Servaes, Christian, Hedlund, Dias, Nelson, Palasis, Rossi and Offiah provide medical–legal expert work in child abuse cases.

Additional information

Thomas L. Slovis passed away before publication of this work was completed.

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Choudhary, A.K., Servaes, S., Slovis, T.L. et al. Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48, 1048–1065 (2018). https://doi.org/10.1007/s00247-018-4149-1

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