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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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References

  1. Narang S (2011) A Daubert analysis of abusive head trauma/shaken baby syndrome. Hous J Health L Pol'y 11:505–633

    Google Scholar 

  2. American Academy of Pediatrics (2015) Understanding abusive head trauma in infants and children: answers from America’s pediatricians. https://www.aap.org/en-us/Documents/cocan_understanding_aht_in_infants_children.pdf. Accessed 17 April 2018

  3. Narang SK, Estrada C, Greenberg S et al (2016) Acceptance of shaken baby syndrome and abusive head trauma as medical diagnoses. J Pediatr 177:273–278

    Article  PubMed  Google Scholar 

  4. Meyer JS, Gunderman R, Coley BD et al (2011) ACR appropriateness criteria® on suspected physical abuse — child. J Am Coll Radiol 8:87–94

    Article  PubMed  Google Scholar 

  5. Strouse PJ (2016) Child abuse: we have problems. Pediatr Radiol 46:587–590

    Article  PubMed  Google Scholar 

  6. Tuerkheimer D (2009) The next innocence project: shaken baby syndrome and the criminal courts. Wash U L Rev 87:1–58

    Google Scholar 

  7. Bazelon E (2011) Shaken-baby syndrome faces new questions in court. New York Times Magazine. http://www.nytimes.com/2011/02/06/magazine/06baby-t.html. Accessed 17 Dec 2015

  8. Keenan HT, Runyan DK, Marshall SW et al (2003) A population-based study of inflicted traumatic brain injury in young children. JAMA 290:621–626

    Article  PubMed  Google Scholar 

  9. Parks SE, Kegler SR, Annest JL et al (2012) Characteristics of fatal abusive head trauma among children in the USA: 2003-2007: an application of the CDC operational case definition to national vital statistics data. Inj Prev 18:193–199

    Article  PubMed  Google Scholar 

  10. Christian CW, Block R, Committee on Child Abuse and Neglect, American Academy of Pediatrics (2009) Abusive head trauma in infants and children. Pediatrics 123:1409–1411

    Article  PubMed  Google Scholar 

  11. Caffey J (1946) Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. Am J Roentgenol Radium Ther 56:163–173

    PubMed  CAS  Google Scholar 

  12. Kempe CH, Silverman FN, Steele BF et al (1962) The battered-child syndrome. JAMA 181:17–24

    Article  PubMed  CAS  Google Scholar 

  13. Caffey J (1972) The parent-infant traumatic stress syndrome; (Caffey-Kempe syndrome), (battered babe syndrome). Am J Roentgenol Radium Therapy Nucl Med 114:218–229

    Article  CAS  Google Scholar 

  14. Caffey J (1972) On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child 124:161–169

    Article  PubMed  CAS  Google Scholar 

  15. Caffey J (1974) The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics 54:396–403

    PubMed  CAS  Google Scholar 

  16. Duhaime AC, Gennarelli TA, Thibault LE et al (1987) The shaken baby syndrome. A clinical, pathological and biomechanical study. J Neurosurg 66:409–415

    Article  PubMed  CAS  Google Scholar 

  17. Kemp AM (2011) Abusive head trauma: recognition and the essential investigation. Arch Dis Child Educ Pract Ed 96:202–208

    Article  PubMed  Google Scholar 

  18. Smith MJ (1950) Subdural hematoma with multiple fractures. AJR Am J Roentgenol 63:342–344

    Google Scholar 

  19. Lis EF, Frauenberger GS (1950) Multiple fractures associated with subdural hematoma in infancy. Pediatrics 6:890–892

    PubMed  CAS  Google Scholar 

  20. Silverman FN (1953) The roentgen manifestations of unrecognized skeletal trauma in infants. Am J Roentgenol Radium Therapy Nucl Med 69:413–427

    CAS  Google Scholar 

  21. Woolley PV Jr, Evans WA Jr (1955) Significance of skeletal lesions in infants resembling those of traumatic origin. J Am Med Assoc 158:539–543

    Article  PubMed  Google Scholar 

  22. Ommaya AK, Yarnell P (1969) Subdural haematoma after whiplash injury. Lancet 2:237–239

    PubMed  CAS  Google Scholar 

  23. Guthkelch AN (1971) Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J 2:430–431

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Kiffney GT Jr (1964) The eye of the "battered child". Arch Ophthalmol 72:231–233

    Article  PubMed  Google Scholar 

  25. Duhaime AC, Alario AJ, Lewander WJ et al (1992) Head injury in very young children: mechanisms, injury types and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 90:179–185

    PubMed  CAS  Google Scholar 

  26. Levin AV, Christian CW, Committee on Child Abuse and Neglect, Section on Ophthalmology (2010) The eye examination in the evaluation of child abuse. Pediatrics 126:376–380

    Article  PubMed  Google Scholar 

  27. Johnson DL, Boal D, Baule R (1995) Role of apnea in nonaccidental head injury. Pediatr Neurosurg 23:305–310

    Article  PubMed  CAS  Google Scholar 

  28. Ichord RN, Naim M, Pollock AN et al (2007) Hypoxic-ischemic injury complicates inflicted and accidental traumatic brain injury in young children: the role of diffusion-weighted imaging. J Neurotrauma 24:106–118

    Article  PubMed  Google Scholar 

  29. Bayir H, Kochanek PM, Kagan VE (2006) Oxidative stress in immature brain after traumatic brain injury. Dev Neurosci 28:420–431

    Article  PubMed  CAS  Google Scholar 

  30. Starling SP, Patel S, Burke BL et al (2004) Analysis of perpetrator admissions to inflicted traumatic brain injury in children. Arch Pediatr Adolesc Med 158:454–458

    Article  PubMed  Google Scholar 

  31. Adamsbaum C, Grabar S, Mejean N et al (2010) Abusive head trauma: judicial admissions highlight violent and repetitive shaking. Pediatrics 126:546–555

    Article  PubMed  Google Scholar 

  32. Vinchon M, de Foort-Dhellemmes S, Desurmont M et al (2010) Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological and ophthalmological data in corroborated cases. Childs Nerv Syst 26:637–645

    Article  PubMed  Google Scholar 

  33. Dias MS (2011) The case for shaking. In: Jenny C (ed) Child abuse and neglect: diagnosis, treatment and evidence. Saunders/Elsevier, St. Louis, pp 364–372

    Chapter  Google Scholar 

  34. Silverman FN (1972) Unrecognized trauma in infants, the battered child syndrome and the syndrome of Ambroise Tardieu. Rigler Lecture Radiology 104:337–353

    PubMed  CAS  Google Scholar 

  35. Jenny C (2003) Modes of presentation of inflicted childhood trauma. In: Reece RM, Nicholson CE (eds) Inflicted childhood neurotrauma: proceedings of a conference sponsored by Department of Health and Human Services, Oct. 10–11, 2002, Bethesda, Maryland American Academy of Pediatrics, S.l., pp 48–63

  36. Arbogast KB, Margulies SS, Christian CW (2005) Initial neurologic presentation in young children sustaining inflicted and unintentional fatal head injuries. Pediatrics 116:180–184

    Article  PubMed  Google Scholar 

  37. Borgialli DA, Mahajan P, Hoyle JD et al (2016) Performance of the pediatric Glasgow coma scale score in the evaluation of children with blunt head trauma. Acad Emerg Med 23:878–884

    Article  PubMed  Google Scholar 

  38. Hettler J, Greenes DS (2003) Can the initial history predict whether a child with a head injury has been abused? Pediatrics 111:602–607

    Article  PubMed  Google Scholar 

  39. Jenny C, Hymel KP, Ritzen A et al (1999) Analysis of missed cases of abusive head trauma. JAMA 281:621–626

    Article  PubMed  CAS  Google Scholar 

  40. Kemp AM, Jaspan T, Griffiths J et al (2011) Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review. Arch Dis Child 96:1103–1112

    Article  PubMed  CAS  Google Scholar 

  41. Maguire SA, Kemp AM, Lumb RC et al (2011) Estimating the probability of abusive head trauma: a pooled analysis. Pediatrics 128:e550–e564

    PubMed  Google Scholar 

  42. Palifka LA, Frasier LD, Metzger RR, Hedlund GL (2016) Parenchymal brain laceration as a predictor of abusive head trauma. AJNR Am J Neuroradiol 37:163–168

  43. Kelly P, John S, Vincent AL et al (2015) Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team. Arch Dis Child 100:1123–1130

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hennes H, Kini N, Palusci VJ (2001) The epidemiology, clinical characteristics and public health implications of shaken baby syndrome. J Aggress Maltreat Trauma 5:19–40

    Article  Google Scholar 

  45. Palusci VJ (2011) Risk factors and services for child maltreatment among infants and young children. Child Youth Serv Rev 33:1374–1382

    Article  Google Scholar 

  46. Feldman KW, Bethel R, Shugerman RP et al (2001) The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics 108:636–646

    Article  PubMed  CAS  Google Scholar 

  47. Dias MS (2002) Inflicted head injury: future directions and prevention. Neurosurg Clin 13:247–257

    Article  Google Scholar 

  48. Abel JM, Gennarelli TA, Segawa H (1978) Incidence and severity of cerebral concussion in the rhesus monkey following sagittal plane angular acceleration. In Proceeding of 22nd Stapp Car Crash Conference, Society for Automotive Engineers, pp 35–53

  49. Margulies SS, Thibault LE, Gennarelli TA (1990) Physical model simulations of brain injury in the primate. J Biomech 23:823–836

    Article  PubMed  CAS  Google Scholar 

  50. Nahum AM, Smith RW (1976) An experimental model for closed head impact injury. In: Proceedings of 20th Stapp Car Crash Conference. Society of Automotive Engineers, pp 783–814

  51. Prange MT, Coats B, Duhaime AC et al (2003) Anthropomorphic simulations of falls, shakes and inflicted impacts in infants. J Neurosurg 99:143–150

    Article  PubMed  Google Scholar 

  52. Chadwick DL, Bertocci G, Castillo E et al (2008) Annual risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics 121:1213–1224

    Article  PubMed  Google Scholar 

  53. Aoki N, Masuzawa H (1984) Infantile acute subdural hematoma. J Neurosurg 61:273–280

    Article  PubMed  CAS  Google Scholar 

  54. Benoit R, Watts DD, Dwyer K et al (2000) Windows 99: a source of suburban pediatric trauma. J Trauma 49:477–481

    Article  PubMed  CAS  Google Scholar 

  55. Claydon SM (1996) Fatal extradural hemorrhage following a fall from a baby bouncer. Pediatr Emerg Care 12:432–434

    Article  PubMed  CAS  Google Scholar 

  56. Denton S, Mileusnic D (2003) Delayed sudden death in an infant following an accidental fall: a case report with review of the literature. Am J Forensic Med Pathol 24:371–376

    Article  PubMed  Google Scholar 

  57. Docherty E, Hassan A, Burke D (2010) Things that go bump ... bump ... bump: an analysis of injuries from falling down stairs in children based at Sheffield Children’s Hospital. Emerg Med J 27:207–208

    Article  PubMed  Google Scholar 

  58. Gruskin KD, Schutzman SA (1999) Head trauma in children younger than 2 years: are there predictors for complications? Arch Pediatr Adolesc Med 153:15–20

    Article  PubMed  CAS  Google Scholar 

  59. Hall JR, Reyes HM, Horvat M et al (1989) The mortality of childhood falls. J Trauma 29:1273–1275

    Article  PubMed  CAS  Google Scholar 

  60. Kim KA, Wang MY, Griffith PM et al (2000) Analysis of pediatric head injury from falls. Neurosurg Focus 8:1–5

    Article  Google Scholar 

  61. Levene S, Bonfield G (1991) Accidents on hospital wards. Arch Dis Child 66:1047–1049

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  62. Joffe M, Ludwig S (1988) Stairway injuries in children. Pediatrics 82:457–461

    PubMed  CAS  Google Scholar 

  63. Murray JA, Chen D, Velmahos GC et al (2000) Pediatric falls: is height a predictor of injury and outcome? Am Surg 66:863–865

    PubMed  CAS  Google Scholar 

  64. Park SH, Cho BM, Oh SM (2004) Head injuries from falls in preschool children. Yonsei Med J 45:229

    Article  PubMed  Google Scholar 

  65. Partington MD, Swanson JA, Meyer FB (1991) Head injury and the use of baby walkers: a continuing problem. Ann Emerg Med 20:652–654

    Article  PubMed  CAS  Google Scholar 

  66. Reiber GD (1993) Fatal falls in childhood. How far must children fall to sustain fatal head injury? Report of cases and review of the literature. Am J Forensic Med Pathol 14:201–207

    Article  PubMed  CAS  Google Scholar 

  67. Ruddick C, Platt MW, Lazaro C (2010) Head trauma outcomes of verifiable falls in newborn babies. Arch Dis Child Fetal Neonatal Ed 95:F144–F145

    PubMed  CAS  Google Scholar 

  68. Sturm V, Knecht PB, Landau K, Menke MN (2009) Rare retinal haemorrhages in translational accidental head trauma in children. Eye 23:1535–1541

  69. Trenchs V, Curcoy AI, Morales M et al (2008) Retinal haemorrhages in head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age. Childs Nerv Syst 24:815–820

    Article  PubMed  CAS  Google Scholar 

  70. Williams RA (1991) Injuries in infants and small children resulting from witnessed and corroborated free falls. J Trauma 31:1350–1352

    Article  PubMed  CAS  Google Scholar 

  71. Zielinski AE, Rochette LM, Smith GA (2012) Stair-related injuries to young children treated in US emergency departments, 1999-2008. Pediatrics 129:721–727

    Article  PubMed  Google Scholar 

  72. Billmire ME, Myers PA (1985) Serious head injury in infants: accident or abuse? Pediatrics 75:340–342

    PubMed  CAS  Google Scholar 

  73. Chadwick DL, Chin S, Salerno C et al (1991) Deaths from falls in children: how far is fatal? J Trauma 31:1353–1355

    Article  PubMed  CAS  Google Scholar 

  74. Chiaviello CT, Christoph RA, Bond GR (1994) Stairway-related injuries in children. Pediatrics 94:679–681

    PubMed  CAS  Google Scholar 

  75. Chiaviello CT, Christoph RA, Bond GR (1994) Infant walker-related injuries: a prospective study of severity and incidence. Pediatrics 93:974–976

    PubMed  CAS  Google Scholar 

  76. Ewing-Cobbs L, Kramer L, Prasad M et al (1998) Neuroimaging, physical and developmental findings after inflicted and noninflicted traumatic brain injury in young children. Pediatrics 102:300–307

    Article  PubMed  CAS  Google Scholar 

  77. Goldstein B, Kelly MM, Bruton D et al (1993) Inflicted versus accidental head injury in critically injured children. Crit Care Med 21:1328–1332

    Article  PubMed  CAS  Google Scholar 

  78. Helfer RE, Slovis TL, Black M (1977) Injuries resulting when small children fall out of bed. Pediatrics 60:533–535

    PubMed  CAS  Google Scholar 

  79. Kelly P, Hayes I (2004) Infantile subdural haematoma in Auckland, New Zealand: 1988-1998. N Z Med J 117:U1047

    PubMed  Google Scholar 

  80. Kravitz H, Driessen G, Gomberg R et al (1969) Accidental falls from elevated surfaces in infants from birth to one year of age. Pediatrics 44:869–876

    Google Scholar 

  81. Lyons TJ, Oates RK (1993) Falling out of bed: a relatively benign occurrence. Pediatrics 92:125–127

    PubMed  CAS  Google Scholar 

  82. Nimityongskul P, Anderson LD (1987) The likelihood of injuries when children fall out of bed. J Pediatr Orthop 7:184–186

    Article  PubMed  CAS  Google Scholar 

  83. Reece RM, Sege R (2000) Childhood head injuries: accidental or inflicted? Arch Pediatr Adolesc Med 154:11–15

    PubMed  CAS  Google Scholar 

  84. Selbst SM, Baker MD, Shames M (1990) Bunk bed injuries. Am J Dis Child 144:721–723

    PubMed  CAS  Google Scholar 

  85. Smith MD, Burrington JD, Woolf AD (1975) Injuries in children sustained in free falls: an analysis of 66 cases. J Trauma 15:987–991

    Article  PubMed  CAS  Google Scholar 

  86. Kahn DJ, Fisher PD, Hertzler DA (2017) Variation in management of in-hospital newborn falls: a single-center experience. J Neurosurg Pediatr 20:176–182

    Article  PubMed  Google Scholar 

  87. Levin AV, Luyet FM, Knox BL (2016) Ophthalmologic concerns in abusive head trauma. J Fam Violence 31:797–804

    Article  Google Scholar 

  88. Gill JR, Goldfeder LB, Armbrustmacher V et al (2009) Fatal head injury in children younger than 2 years in New York City and an overview of the shaken baby syndrome. Arch Pathol Lab Med 133:619–627

    PubMed  Google Scholar 

  89. Kivlin JD, Simons KB, Lazoritz S, Ruttum MS (2000) Shaken baby syndrome. Ophthalmology 107:1246–1254

  90. Morad Y, Kim YM, Armstrong DC et al (2002) Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome. Am J Ophthalmol 134:354–359

    Article  PubMed  Google Scholar 

  91. Morad Y, Wygnansky-Jaffe T, Levin AV (2010) Retinal haemorrhage in abusive head trauma. Clin Exp Ophthalmol 38:514–520

    Article  PubMed  Google Scholar 

  92. Agrawal S, Peters MJ, Adams GGW et al (2012) Prevalence of retinal hemorrhages in critically ill children. Pediatrics 129:e1388–e1396

    Article  PubMed  Google Scholar 

  93. Levin AV (2010) Retinal hemorrhage in abusive head trauma. Pediatrics 126:961–970

    Article  PubMed  Google Scholar 

  94. Binenbaum G, Chen W, Huang J et al (2016) The natural history of retinal hemorrhage in pediatric head trauma. J AAPOS 20:131–135

    Article  PubMed  PubMed Central  Google Scholar 

  95. Servaes S, Brown SD, Choudhary AK et al (2016) The etiology and significance of fractures in infants and young children: a critical multidisciplinary review. Pediatr Radiol 46:591–600

    Article  PubMed  Google Scholar 

  96. Anderst JD, Carpenter SL, Abshire TC et al (2013) Evaluation for bleeding disorders in suspected child abuse. Pediatrics 131:e1314–e1322

    Article  PubMed  Google Scholar 

  97. Choudhary AK, Jha B, Boal DK, Dias M (2010) Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT? Surg Radiol Anat 32:807–816

    Article  PubMed  Google Scholar 

  98. Kemp AM, Rajaram S, Mann M et al (2009) What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clin Radiol 64:473–483

    Article  PubMed  CAS  Google Scholar 

  99. Barber I, Kleinman PK (2014) Imaging of skeletal injuries associated with abusive head trauma. Pediatr Radiol 44:S613–S620

    Article  PubMed  Google Scholar 

  100. Girard N, Brunel H, Dory-Lautrec P et al (2016) Neuroimaging differential diagnoses to abusive head trauma. Pediatr Radiol 46:603–614

    Article  PubMed  Google Scholar 

  101. Slovis TL, Strouse PJ, Strauss KJ (2015) Radiation exposure in imaging of suspected child abuse: benefits versus risks. J Pediatr 167:963–968

    Article  PubMed  Google Scholar 

  102. Kuppermann N, Holmes JF, Dayan PS et al (2009) Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374:1160–1170

    Article  PubMed  Google Scholar 

  103. Magana JN, Kuppermann N (2017) The PECARN TBI rules do not apply to abusive head trauma. Acad Emerg Med 24:382–384

    Article  PubMed  Google Scholar 

  104. National Association of Children’s Hospitals and Related Institutions (2011) Defining the children’s hospital role in child maltreatment, 2nd edn. https://www.childrenshospitals.org/~/media/Files/CHA/Main/Issues_and_Advocacy/Key_Issues/Child_Health/Child_Abuse/child_abuse_guidelines_100111.pdf. Accessed 05 June 2017

  105. Bechtel K, Stoessel K, Leventhal JM et al (2004) Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics 114:165–168

    Article  PubMed  Google Scholar 

  106. Ewing-Cobbs L, Prasad M, Kramer L et al (2000) Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Childs Nerv Syst 16:25–33

    Article  PubMed  CAS  Google Scholar 

  107. Myhre MC, Grogaard JB, Dyb GA et al (2007) Traumatic head injury in infants and toddlers. Acta Paediatr 96:1159–1163

    Article  PubMed  CAS  Google Scholar 

  108. Tung GA, Kumar M, Richardson RC et al (2006) Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 118:626–633

    Article  PubMed  Google Scholar 

  109. Hedlund G (2015) Abusive head trauma: extraaxial hemorrhage and nonhemic collections. In: Kleinman PK (ed) Diagnostic imaging of child abuse. Cambridge University Press, Cambridge, pp 394–452

    Chapter  Google Scholar 

  110. Bradford R, Choudhary AK, Dias MS (2013) Serial neuroimaging in infants with abusive head trauma: timing abusive injuries. J Neurosurg Pediatr 12:110–119

    Article  PubMed  Google Scholar 

  111. Zouros A, Bhargava R, Hoskinson M et al (2004) Further characterization of traumatic subdural collections of infancy. J Neurosurg Pediatr 100:512–518

    Article  Google Scholar 

  112. Vezina G (2009) Assessment of the nature and age of subdural collections in nonaccidental head injury with CT and MRI. Pediatr Radiol 39:586–590

    Article  PubMed  Google Scholar 

  113. Grant P (2015) Abusive head trauma: parenchymal injury. In: Kleinman PK (ed) Diagnostic imaging of child abuse. Cambridge University Press, Cambridge, pp 453–486

    Chapter  Google Scholar 

  114. Choudhary AK, Bradford R, Dias MS et al (2015) Venous injury in abusive head trauma. Pediatr Radiol 45:1803–1813

    Article  PubMed  Google Scholar 

  115. Nelson MD Jr (2009) Unraveling the puzzle. Pediatr Radiol 39:199

    Article  PubMed  Google Scholar 

  116. Mack J, Squier W, Eastman J (2009) Anatomy and development of the meninges: implications for subdural collections and CSF circulation. Pediatr Radiol 39:200–210

    Article  PubMed  Google Scholar 

  117. Choudhary AK, Ishak R, Zacharia TT et al (2014) Imaging of spinal injury in abusive head trauma: a retrospective study. Pediatr Radiol 44:1130–1140

    Article  PubMed  Google Scholar 

  118. Kemp A, Cowley L, Maguire S (2014) Spinal injuries in abusive head trauma: patterns and recommendations. Pediatr Radiol 44:S604–S612

    Article  PubMed  Google Scholar 

  119. Choudhary AK, Bradford RK, Dias MS et al (2012) Spinal subdural hemorrhage in abusive head trauma: a retrospective study. Radiology 262:216–223

    Article  PubMed  Google Scholar 

  120. Brennan LK, Rubin D, Christian CW et al (2009) Neck injuries in young pediatric homicide victims. J Neurosurg Pediatr 3:232–239

    Article  PubMed  Google Scholar 

  121. Koumellis P, McConachie NS, Jaspan T (2009) Spinal subdural haematomas in children with non-accidental head injury. Arch Dis Child 94:216–219

    Article  PubMed  CAS  Google Scholar 

  122. Bandak FA (2005) Shaken baby syndrome: biomechanics analysis of injury mechanisms. Forensic Sci Int 151:71–79

    Article  PubMed  Google Scholar 

  123. Woodall TT (2009) In the court of criminal appeals of Tennessee at Nashville. www.tba.org/tba_files/TCCA/2010/mazer_110210.pdf. Accessed on 30 July 2017

  124. Gabaeff SC (2011) Challenging the pathophysiologic connection between subdural hematoma, retinal hemorrhage and shaken baby syndrome. West J Emerg Med 12:144–158

    PubMed  PubMed Central  Google Scholar 

  125. Leventhal JM, Edwards GA (2017) Flawed theories to explain child physical abuse: what are the medical-legal consequences? JAMA 318:1317–1318

    Article  PubMed  Google Scholar 

  126. Martin-Millan M, Hernandez JL, Matorras P et al (2005) Multiple subdural haematomas following lumbar puncture. Eur Neurol 53:159–160

    Article  PubMed  CAS  Google Scholar 

  127. Lee AC, Lau Y, Li CH et al (2007) Intraspinal and intracranial hemorrhage after lumbar puncture. Pediatr Blood Cancer 48:233–237

    Article  PubMed  Google Scholar 

  128. Openshaw H, Ressler JA, Snyder DS (2008) Lumbar puncture and subdural hygroma and hematomas in hematopoietic cell transplant patients. Bone Marrow Transplant 41:791–795

    Article  PubMed  CAS  Google Scholar 

  129. Brown MW, Yilmaz TS, Kasper EM (2016) Iatrogenic spinal hematoma as a complication of lumbar puncture: what is the risk and best management plan? Surg Neurol Int 7:S581–S589

    Article  PubMed  PubMed Central  Google Scholar 

  130. Talbert DG (2005) Paroxysmal cough injury, vascular rupture and 'shaken baby syndrome'. Med Hypotheses 64:8–13

    Article  PubMed  CAS  Google Scholar 

  131. Geddes JF, Talbert DG (2006) Paroxysmal coughing, subdural and retinal bleeding: a computer modelling approach. Neuropathol Appl Neurobiol 32:625–634

    Article  PubMed  CAS  Google Scholar 

  132. Watts CC, Acosta C (1969) Pertussis and bilateral subdural hematomas. Am J Dis Child 118:518–519

    PubMed  CAS  Google Scholar 

  133. Curcoy AI, Trenchs V, Morales M et al (2012) Is pertussis in infants a potential cause of retinal haemorrhages? Arch Dis Child 97:239–240

    Article  PubMed  Google Scholar 

  134. Raoof N, Pereira S, Dai S et al (2017) Retinal haemorrhage in infants with pertussis. Arch Dis Child 102:1158–1160

    Article  PubMed  Google Scholar 

  135. Barnes PD, Galaznik J, Gardner H, Shuman M (2010) Infant acute life-threatening event --dysphagic choking versus nonaccidental injury. Semin Pediatr Neurol 17:7–11

  136. Barnes PD (2011) Imaging of nonaccidental injury and the mimics: issues and controversies in the era of evidence-based medicine. Radiol Clin N Am 49:205–229

    Article  PubMed  Google Scholar 

  137. Greeley CS (2010) Infant fatality. Semin Pediatr Neurol 17:275–278

    Article  PubMed  Google Scholar 

  138. Edwards GA (2015) Mimics of child abuse: can choking explain abusive head trauma? J Forensic Legal Med 35:33–37

    Article  Google Scholar 

  139. Curcoy AI, Trenchs V, Morales M et al (2010) Retinal hemorrhages and apparent life-threatening events. Pediatr Emerg Care 26:118–120

    Article  PubMed  Google Scholar 

  140. Bonkowsky JL, Guenther E, Filloux FM et al (2008) Death, child abuse and adverse neurological outcome of infants after an apparent life-threatening event. Pediatrics 122:125–131

    Article  PubMed  Google Scholar 

  141. Hansen JB, Frazier T, Moffatt M et al (2017) Evaluation of the hypothesis that choking/ALTE may mimic abusive head trauma. Acad Pediatr 17:362–367

    Article  PubMed  Google Scholar 

  142. Herr S, Pierce MC, Berger RP et al (2004) Does valsalva retinopathy occur in infants? An initial investigation in infants with vomiting caused by pyloric stenosis. Pediatrics 113:1658–1661

    Article  PubMed  Google Scholar 

  143. Geddes JF, Tasker RC, Hackshaw AK et al (2003) Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in 'shaken baby syndrome'? Neuropathol Appl Neurobiol 29:14–22

    Article  PubMed  CAS  Google Scholar 

  144. Cohen MC, Scheimberg I (2009) Evidence of occurrence of intradural and subdural hemorrhage in the perinatal and neonatal period in the context of hypoxic ischemic encephalopathy: an observational study from two referral institutions in the United Kingdom. Pediatr Dev Pathol 12:169–176

    Article  PubMed  Google Scholar 

  145. Punt J, Bonshek RE, Jaspan T et al (2004) The 'unified hypothesis' of Geddes et al. is not supported by the data. Pediatr Rehabil 7:173–184

    Article  PubMed  CAS  Google Scholar 

  146. Rao P, Carty H, Pierce A (1999) The acute reversal sign: comparison of medical and non-accidental injury patients. Clin Radiol 54:495–501

    Article  PubMed  CAS  Google Scholar 

  147. Byard RW, Blumbergs P, Rutty G et al (2007) Lack of evidence for a causal relationship between hypoxic-ischemic encephalopathy and subdural hemorrhage in fetal life, infancy and early childhood. Pediatr Dev Pathol 10:348–350

    Article  PubMed  Google Scholar 

  148. Hurley M, Dineen R, Padfield CJH et al (2010) Is there a causal relationship between the hypoxia-ischaemia associated with cardiorespiratory arrest and subdural haematomas? An observational study. Br J Radiol 83:736–743

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  149. Bailey OT, Hass GM (1937) Dural sinus thrombosis in early life: recovery from acute thrombosis of the superior longitudinal sinus and its relation to certain acquired cerebral lesions in childhood. Brain 60:293–314

    Article  Google Scholar 

  150. Matsuda M, Matsuda I, Sato M et al (1982) Superior sagittal sinus thrombosis followed by subdural hematoma. Surg Neurol 18:206–211

    Article  PubMed  CAS  Google Scholar 

  151. Bucy PC, Lesemann FJ (1942) Idiopathic recurrent thrombophlebitis: with cerebral venous thromboses and an acute subdural hematoma. JAMA 119:402–405

    Article  Google Scholar 

  152. Hedlund GL (2013) Cerebral sinovenous thrombosis in pediatric practice. Pediatr Radiol 43:173–188

    Article  PubMed  Google Scholar 

  153. Sebire G, Tabarki B, Saunders DE et al (2005) Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain 128:477–489

    Article  PubMed  CAS  Google Scholar 

  154. Bracken J, Barnacle A, Ditchfield M (2013) Potential pitfalls in imaging of paediatric cerebral sinovenous thrombosis. Pediatr Radiol 43:219–231

    Article  PubMed  Google Scholar 

  155. Heller C, Heinecke A, Junker R et al (2003) Cerebral venous thrombosis in children: a multifactorial origin. Circulation 108:1362–1367

    Article  PubMed  Google Scholar 

  156. deVeber G, Andrew M, Adams C et al (2001) Cerebral sinovenous thrombosis in children. N Engl J Med 345:417–423

    Article  PubMed  CAS  Google Scholar 

  157. McLean LA, Frasier LD, Hedlund GL (2012) Does intracranial venous thrombosis cause subdural hemorrhage in the pediatric population? AJNR Am J Neuroradiol 33:1281–1284

    Article  PubMed  CAS  Google Scholar 

  158. Wilms G, Vanderschueren G, Demaerel PH et al (1993) CT and MR in infants with pericerebral collections and macrocephaly: benign enlargement of the subarachnoid spaces versus subdural collections. AJNR Am J Neuroradiol 14:855–860

    PubMed  CAS  Google Scholar 

  159. McKeag H, Christian CW, Rubin D et al (2013) Subdural hemorrhage in pediatric patients with enlargement of the subarachnoid spaces. J Neurosurg Pediatr 11:438–444

    Article  PubMed  Google Scholar 

  160. Tucker J, Choudhary AK, Piatt J (2016) Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections. J Neurosurg Pediatr 18:16–20

    Article  PubMed  Google Scholar 

  161. Greiner MV, Richards TJ, Care MM et al (2013) Prevalence of subdural collections in children with macrocrania. AJNR Am J Neuroradiol 34:2373–2378

    Article  PubMed  CAS  Google Scholar 

  162. McNeely PD, Atkinson JD, Saigal G et al (2006) Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. AJNR Am J Neuroradiol 27:1725–1728

    PubMed  CAS  Google Scholar 

  163. Haws ME, Linscott L, Thomas C et al (2017) A retrospective analysis of the utility of head computed tomography and/or magnetic resonance imaging in the management of benign macrocrania. J Pediatr 182:283–289

    Article  PubMed  Google Scholar 

  164. Alper G, Ekinci G, Yilmaz Y et al (1999) Magnetic resonance imaging characteristics of benign macrocephaly in children. J Child Neurol 14:678–682

    Article  PubMed  CAS  Google Scholar 

  165. Hansen JB, Frazier T, Moffatt M et al (2018) Evaluations for abuse in young children with subdural hemorrhages: findings based on symptom severity and benign enlargement of the subarachnoid spaces. J Neurosurg Pediatr 21:31–37

    Article  PubMed  Google Scholar 

  166. Towner D, Castro MA, Eby-Wilkens E et al (1999) Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med 341:1709–1714

    Article  PubMed  CAS  Google Scholar 

  167. Abroms IF, McLennan JE, Mandell F (1977) Acute neonatal subdural hematoma following breech delivery. Am J Dis Child 131:192–194

    PubMed  CAS  Google Scholar 

  168. Bergman I, Bauer RE, Barmada MA et al (1985) Intracerebral hemorrhage in the full-term neonatal infant. Pediatrics 75:488–496

    Article  PubMed  CAS  Google Scholar 

  169. Gresham EL (1975) Birth trauma. Pediatr Clin N Am 22:317–328

    Article  CAS  Google Scholar 

  170. Hanigan WC, Morgan AM, Stahlberg LK et al (1990) Tentorial hemorrhage associated with vacuum extraction. Pediatrics 85:534–539

    PubMed  CAS  Google Scholar 

  171. Hernansanz J, Munoz F, Rodriguez D et al (1984) Subdural hematomas of the posterior fossa in normal-weight newborns. Report of two cases. J Neurosurg 61:972–974

    Article  PubMed  CAS  Google Scholar 

  172. Hickey K, McKenna P (1996) Skull fracture caused by vacuum extraction. Obstet Gynecol 88:671–673

    Article  PubMed  CAS  Google Scholar 

  173. Hill A, Martin DJ, Daneman A et al (1983) Focal ischemic cerebral injury in the newborn: diagnosis by ultrasound and correlation with computed tomographic scan. Pediatrics 71:790–793

    PubMed  CAS  Google Scholar 

  174. Hovind KH (1986) Traumatic birth injuries. In: Raimondi AJ, Choux M, Di Rocco C (eds) Head injuries in the newborn and infant. Springer, New York, pp 87–109

    Chapter  Google Scholar 

  175. Leblanc R, O'Gorman AM (1980) Neonatal intracranial hemorrhage. A clinical and serial computerized tomographic study. J Neurosurg 53:642–651

    Article  PubMed  CAS  Google Scholar 

  176. Mannino FL, Trauner DA (1983) Stroke in neonates. J Pediatr 102:605–610

    Article  PubMed  CAS  Google Scholar 

  177. Menezes AH, Smith DE, Bell WE (1983) Posterior fossa hemorrhage in the term neonate. Neurosurgery 13:452–456

    Article  PubMed  CAS  Google Scholar 

  178. Natelson SE, Sayers MP (1973) The fate of children sustaining severe head trauma during birth. Pediatrics 51:169–174

    PubMed  CAS  Google Scholar 

  179. Perrin RG, Rutka JT, Drake JM et al (1997) Management and outcomes of posterior fossa subdural hematomas in neonates. Neurosurgery 40:1190–1199

    Article  PubMed  CAS  Google Scholar 

  180. Pollina J, Dias MS, Li V et al (2001) Cranial birth injuries in term newborn infants. Pediatr Neurosurg 35:113–119

    Article  PubMed  CAS  Google Scholar 

  181. Ravenel SD (1979) Posterior fossa hemorrhage in the term newborn: report of two cases. Pediatrics 64:39–42

    PubMed  CAS  Google Scholar 

  182. Roessmann U, Miller RT (1980) Thrombosis of the middle cerebral artery associated with birth trauma. Neurology 30:889–892

    Article  PubMed  CAS  Google Scholar 

  183. Romodanov AP, Brodsky Yu S (1987) Subdural hematomas in the newborn. Surgical treatment and results. Surg Neurol 28:253–258

    Article  PubMed  CAS  Google Scholar 

  184. Takagi T, Fukuoka H, Wakabayashi S et al (1982) Posterior fossa subdural hemorrhage in the newborn as a result of birth trauma. Childs Brain 9:102–113

    PubMed  CAS  Google Scholar 

  185. Looney CB, Smith JK, Merck LH et al (2007) Intracranial hemorrhage in asymptomatic neonates: prevalence on MR images and relationship to obstetric and neonatal risk factors. Radiology 242:535–541

    Article  PubMed  Google Scholar 

  186. Rooks VJ, Eaton JP, Ruess L et al (2008) Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. AJNR Am J Neuroradiol 29:1082–1089

    Article  PubMed  CAS  Google Scholar 

  187. Whitby EH, Griffiths PD, Rutter S et al (2004) Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 363:846–851

    Article  PubMed  CAS  Google Scholar 

  188. Uscinski RH, McBride DK (2008) The shaken baby syndrome: an odyssey. II Origins and further hypotheses. Neurol Med Chir 48:151–155

    Article  Google Scholar 

  189. Holden KR, Titus MO, Van Tassel P (1999) Cranial magnetic resonance imaging examination of normal term neonates: a pilot study. J Child Neurol 14:708–710

    Article  PubMed  CAS  Google Scholar 

  190. Kolbo JR, Strong E (1997) Multidisciplinary team approaches to the investigation and resolution of child abuse and neglect: a national survey. Child Maltreat 2:61–72

    Article  Google Scholar 

  191. Palusci VJ, Covington TM (2014) Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System. Child Abuse Negl 38:25–36

    Article  PubMed  Google Scholar 

  192. Schnitzer PG, Ewigman BG (2005) Child deaths resulting from inflicted injuries: household risk factors and perpetrator characteristics. Pediatrics 116:e687–e693

    Article  PubMed  PubMed Central  Google Scholar 

  193. Spies EL, Klevens J (2016) Fatal abusive head trauma among children aged <5 years — United States, 1999–2014. MMWR Morb Mortal Wkly Rep 65:505–509

    Article  PubMed  Google Scholar 

  194. U. S. Department of Health and Human Services; Administration for Children and Families; Administration on Children, Youth and Families; Children’s Bureau (2018) Child maltreatment 2016. https://www.acf.hhs.gov/sites/default/files/cb/cm2016.pdf. Accessed 29 March 2018

  195. Palusci VJ, Smith EG, Paneth N (2005) Predicting and responding to physical abuse in young children using NCANDS. Child Youth Serv Rev 27:667–682

    Article  Google Scholar 

  196. Chevignard MP, Lind K (2014) Long-term outcome of abusive head trauma. Pediatr Radiol 44:S548–S558

    Article  PubMed  Google Scholar 

  197. Miller TR, Steinbeigle R, Lawrence BA et al (2017) Lifetime cost of abusive head trauma at ages 0–4, USA. Prev Sci. https://doi.org/10.1007/s11121-017-0815-z

  198. Paul SR, Narang SK, Committee on Medical Liability and Risk Management (2017) Expert witness participation in civil and criminal proceedings. Pediatrics 139(3)

  199. Chadwick DL, Krous HF (1997) Irresponsible testimony by medical experts in cases involving the physical abuse and neglect of children. Child Maltreat 2:313–321

    Article  Google Scholar 

  200. Whiting P, Rutjes AW, Reitsma JB et al (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25

    Article  PubMed  PubMed Central  Google Scholar 

  201. Donohoe M (2003) Evidence-based medicine and shaken baby syndrome: part I: literature review, 1966-1998. Am J Forensic Med Pathol 24:239–242

    Article  PubMed  Google Scholar 

  202. Lynoe N, Elinder G, Hallberg B et al (2017) Insufficient evidence for 'shaken baby syndrome' — a systematic review. Acta Paediatr 106:1021–1027

    Article  PubMed  Google Scholar 

  203. Narang SK, Greeley CS (2017) Lynoe et al.- #theRestoftheStory. Acta Paediatr 106:1047–1049

    Article  PubMed  Google Scholar 

  204. Greeley CS (2015) Abusive head trauma: a review of the evidence base. AJR Am J Roentgenol 204:967–973

    Article  PubMed  Google Scholar 

  205. Hill AB (1965) The environment and disease: association or causation? Proc R Soc Med 58:295–300

    PubMed  PubMed Central  CAS  Google Scholar 

  206. Bilo RAC, Banaschak S, Herrmann B et al (2017) Using the table in the Swedish review on shaken baby syndrome will not help courts deliver justice. Acta Paediatr 106:1043–1045

    Article  PubMed  Google Scholar 

  207. Hellgren K, Hellstrom A, Hard AL et al (2017) The new Swedish report on shaken baby syndrome is misleading. Acta Paediatr 106:1040

    Article  PubMed  Google Scholar 

  208. Lucas S, Bärtås A, Bonamy A-KE et al (2017) The way forward in addressing abusive head trauma in infants — current perspectives from Sweden. Acta Paediatr 106:1033–1035

    Article  PubMed  Google Scholar 

  209. Levin AV (2017) The SBU report: a different view. Acta Paediatr 106:1037–1039

    Article  PubMed  Google Scholar 

  210. Saunders D, Raissaki M, Servaes S et al (2017) Throwing the baby out with the bath water — response to the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) report on traumatic shaking. Pediatr Radiol 47:1386–1389

    Article  PubMed  PubMed Central  Google Scholar 

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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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  4. Vincent J. Palusci
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  5. Gary L. Hedlund
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  6. Sandeep K. Narang
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  8. Mark S. Dias
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  9. Cindy W. Christian
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  15. Amaka C. Offiah
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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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