1
|
Hahnemann ML, Kronsbein K, Karger B, Feld K, Banaschak S, Helmus J, Mentzel HJ, Pfeiffer H, Wittschieber D. Characterization of subdural collections in initial neuroimaging of abusive head trauma: Implications for forensic age diagnostics and clinical decision-making. Eur J Radiol 2023; 159:110652. [PMID: 36577185 DOI: 10.1016/j.ejrad.2022.110652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Subdural collections (SDCs) represent a key finding in abusive head trauma (AHT), a serious form of child physical abuse. Common SDC entities in this context are subdural hematoma (SDH), subdural hygroma (SDHy), subdural hematohygroma (SDHHy), and chronic subdural hematoma (cSDH). The present study examines the prevalence of the different SDC entities and investigates the influence of the SDC diagnosis on the forensic age estimation of the injury. METHODS In this retrospective multi-center study from three German university hospitals of a 10-year period, the initial neuroimaging material (CT or MRI) of 56 children (36 males, 20 females; age median 3.9 months) with medico-legally well-documented AHT was analyzed. SDCs were characterized by determining presence, location, extension, and visual appearance, by assigning to one of the five entities, and by categorizing with three different classification systems, one of which represents a novel system based on focality and Mixed Appearance Pattern and especially developed for children with AHT. The data were correlated with demographic and clinical data. By means of court files, AHT cases were also sub-divided into confession (n = 14) and non-confession cases (n = 42) and then compared. RESULTS Most cases showed a multifocal presence of SDCs (96.4%) and the presence of a Mixed Appearance Pattern (82.1%). The most common SDC entity was the heterogeneous variant of the SDHHy (66.1%). The cSDH occurred infrequently only (3.6%). Our novel classification system illustrates that unifocal SDCs rarely occur in AHT, and that more complex SDC patterns are common. In nearly all cases (94.6%), additional signs of recently caused brain injury were present beside the SDCs. Comparison between confession and non-confession groups did not reveal any significant differences, indicating that the diagnostic criteria of AHT are robust. CONCLUSIONS Although precise dating of SDCs based on initial neuroimaging alone remains unrealistic, the exact diagnosis of the SDC entity provide an important basis for differentiation between acute trauma and chronic post-traumatic state. Therefore, especially the confirmation or exclusion of subdural neomembranes, that define the cSDH, should be considered indispensable.
Collapse
Affiliation(s)
- Maria L Hahnemann
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany; Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katharina Kronsbein
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Westfalian Wilhelms University Münster, Münster, Germany; Institute of Legal Medicine, University Hospital Münster, Westfalian Wilhelms University Münster, Münster, Germany
| | - Bernd Karger
- Institute of Legal Medicine, University Hospital Münster, Westfalian Wilhelms University Münster, Münster, Germany
| | - Katharina Feld
- Institute of Legal Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Sibylle Banaschak
- Institute of Legal Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Janine Helmus
- Formerly, Institute of Legal Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Heidi Pfeiffer
- Institute of Legal Medicine, University Hospital Münster, Westfalian Wilhelms University Münster, Münster, Germany
| | - Daniel Wittschieber
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
| |
Collapse
|
2
|
Hendrix AD, Conway LK, Baxter MA. Legal Outcomes of Suspected Maltreatment Cases Evaluated by a Child Abuse Pediatrician as Part of a Multidisciplinary Team Investigation. J Forensic Sci 2020; 65:1517-1523. [DOI: 10.1111/1556-4029.14463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Amy D. Hendrix
- School of Community Medicine University of Oklahoma‐Tulsa 4502 E. 41st Street Tulsa OK74135
| | - Lauren K. Conway
- School of Community Medicine University of Oklahoma‐Tulsa 4502 E. 41st Street Tulsa OK74135
| | - Michael A. Baxter
- School of Community Medicine University of Oklahoma‐Tulsa 4502 E. 41st Street Tulsa OK74135
| |
Collapse
|