Abstract
Claims that new science is changing accepted medical opinion about abusive head injury have been made frequently in the media, legal publications, and in legal cases involving abusive head trauma (AHT). This review analyzes recently published scientific articles about AHT to determine whether this new information has led to significant changes in the understanding, evaluation, and management of children with suspected AHT. Several specific topics are examined as follows: serious or fatal injuries from short falls, specificity of subdural hematoma for severe trauma, biomechanical explanations for findings, the specificity of retinal hemorrhages, the possibility of cerebral sinus thrombosis presenting with signs similar to AHT, and whether vaccines can produce such findings. We conclude (a) that the overwhelming weight of recent data does not change the fundamental consensus, (b) that abusive head trauma is a significant source of morbidity and mortality in children, (c) that subdural hematomas and severe retinal hemorrhages are commonly the results of severe trauma, (d) that these injuries should prompt an evaluation for abuse when identified in young children without a history of such severe trauma, and (e) that short falls, cerebral sinus thrombosis, and vaccinations are not plausible explanations for findings that raise concern for abusive head trauma.
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Funding
Dr. Lindberg’s effort was supported by the National Institutes of Health, the Eunice Kennedy Schrivar National Institute of Child Health and Human Development K23HD083559. No other funding support was obtained.
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The authors have each provided expert witness testimony in cases with alleged child physical abuse.
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Lindberg, D.M., Dubowitz, H., Alexander, R.C. et al. The “New Science” of Abusive Head Trauma. Int. Journal on Child Malt. 2, 1–16 (2019). https://doi.org/10.1007/s42448-019-00021-w
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DOI: https://doi.org/10.1007/s42448-019-00021-w