Fractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study

Affiliation
Institute of Legal Medicine, University Hospital Cologne, Cologne, Germany
Feld, Katharina;
Affiliation
Institute of Legal Medicine, University Hospital Münster, Münster, Germany
Ricken, Tim;
Affiliation
adiutaByte GmbH, Business Campus, Sankt Augustin, Germany
Feld, Dustin;
Affiliation
Institute of Legal Medicine, University Hospital Essen, Essen, Germany
Helmus, Janine;
Affiliation
Division of Radiology, Medical Practice, Jena, Germany
Hahnemann, Maria;
GND
1215280556
Affiliation
Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
Schenkl, Sebastian;
Affiliation
Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
Muggenthaler, Holger;
Affiliation
Institute of Legal Medicine, University Hospital Münster, Münster, Germany
Pfeiffer, Heidi;
Affiliation
Institute of Legal Medicine, University Hospital Cologne, Cologne, Germany
Banaschak, Sibylle;
Affiliation
Institute of Legal Medicine, University Hospital Münster, Münster, Germany
Karger, Bernd;
GND
1022638718
ORCID
0000-0003-1344-7488
Affiliation
Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
Wittschieber, Daniel

Abstract Abusive head trauma (AHT) and its most common variant, the shaken baby syndrome (SBS), are predominantly characterized by central nervous system-associated lesions. Relatively little data are available on the value of skeletal and skin injuries for the diagnosis of SBS or AHT. Thus, the present study retrospectively investigated 72 cases of living children diagnosed with the explicit diagnosis of SBS during medico-legal examinations at three German university institutes of legal medicine. The risk of circular reasoning was reduced by the presence of 15 cases with confession by perpetrators. Accordingly, the comparison with the 57 non-confession cases yielded no significant differences. Skeletal survey by conventional projection radiography, often incomplete, was found to be performed in 78% of the cases only. Fractures were found in 32% of the cases. The skull (43%) and ribs (48%) were affected most frequently; only 8% of the cases showed classic metaphyseal lesions. In 48% of the cases, healing fractures were present. Skin lesions (hematomas and abrasions) were found in 53% of the cases with the face (76%), scalp (26%), and trunk (50%) being the major sites. In 48% of the cases, healing skin lesions were observed. Nearly 80% of the cases with fractures also showed skin lesions. The data prove that SBS is frequently accompanied by other forms of physical abuse. Therefore, skeletal survey is indispensable and should always be done completely and according to existing imaging guidelines if child abuse is suspected.

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