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Multicenter Study
. 2022 Mar;136(2):591-601.
doi: 10.1007/s00414-021-02751-4. Epub 2021 Dec 3.

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

Katharina Feld  1 , Tim Ricken  2 , Dustin Feld  3 , Janine Helmus  4 , Maria Hahnemann  5 , Sebastian Schenkl  6 , Holger Muggenthaler  6 , Heidi Pfeiffer  2 , Sibylle Banaschak  1 , Bernd Karger  2 , Daniel Wittschieber  7
Affiliations
Multicenter Study

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

Katharina Feld et al. Int J Legal Med. 2022 Mar.

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.

Keywords: Child abuse; Fracture; Hematoma; Injury pattern; Skeletal survey.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Synopsis of the frequency and locations of fractures found in 23 AHT cases. Paired locations are shown only once, but apply for both body sides. n=number of cases
Fig. 2
Fig. 2
Graphical visualization of the frequency of skin lesions. The numbers at the different body regions (front side, left; back side, right) indicate case numbers of the total study cohort. The case numbers shown at the extremities include both front and back sides
See this image and copyright information in PMC

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