proposed as the highest ranking for a diagnosis of AHT “abuse confirmed at case conference or civil, family, or criminal court proceeding, or admitted by the perpetrator or independently witnessed”. If SDH is detected in an infant in the absence of a witnessed accident or disease known to cause SDH, abuse can be inferred from the history given by the parents or caregivers. Those authors concluded that it is not possible to categorically rule out shaking as a cause in lethal brain injury.ĭuhaime’s algorithm also has been employed in clinical observational studies, case series, and cross-sectional studies of establishing an abuse diagnosis. One biofidelic study challenged these findings, however, by generating higher forces if certain parameters were changed. Two reports on use of biofidelic dolls offered similar conclusions. found that the forces causing subdural haemorrhage in the experimental model in that study could only be produced by an impact load that not even the most violent shaking could give rise to. questioned the reasoning of Caffey and Guthkelch, who hypothesised shaking as a mechanism for SDH, RH, and encephalopathy in his study of rhesus monkeys subjected to a single severe inertial load. īiomechanical research has addressed the forces derived from shaking.

According to another algorithm, this collective of signs makes a diagnosis of abuse “highly probable”. For detection of SBS/AHT, a common tool is the Duhaime algorithm, which classifies as “suspicious, but not presumptive for inflicted injury” the failure of a caretaker to provide a plausible trauma history that could account for such findings. This collective of putative signs of abuse exposure was designated as shaken baby syndrome (SBS), which was changed in 2009 to abusive head trauma (AHT) to include blunt force trauma. suggested that the thoracic compression exerted during violent shaking was associated with rib fractures, especially posteriorly, and that the torsional and tractional forces resulted in the classic metaphyseal lesions (CMLs) known as “bucket-handle” and “corner” fractures. Three years later, radiologist John Caffey described the combination of subdural haematoma (SDH), retinal haemorrhages (RHs), and clinical signs of brain injury as highly suggestive for whiplash shaking. The hypothesis was partly based on a whiplash study in rhesus monkeys subjected to a single acceleration inertial load of 600 G. In 1971, paediatric neurosurgeon Norman Guthkelch proposed that subdural haematoma in infants and toddlers without evidence of blunt force trauma may be caused by a whiplash mechanism arising from forces elicited through shaking. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Göran Högberg has written statements and appeared in court in child abuse cases on the request of the defence. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the manuscript and its Supporting Information files.įunding: The authors received no specific funding for this research.Ĭompeting interests: Ingemar Thiblin, Ulf Högberg, Knut Wester and Johan Wikström have written statements and appeared in court in child abuse cases both on the request of the prosecutor and the defence.

PLoS ONE 15(10):Įditor: Itamar Ashkenazi, Technion - Israel Institute of Technology, ISRAEL

Citation: Thiblin I, Andersson J, Wester K, Wikström J, Högberg G, Högberg U (2020) Medical findings and symptoms in infants exposed to witnessed or admitted abusive shaking: A nationwide registry study.

Signs of abusive head trauma