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Pediatric Abusive Head Trauma: A Systematic Review
Aniello Maiese1,2, Francesca Iannaccone1, Andrea Scatena1
1Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy.
Insights
Diagnosing abusive head trauma (AHT) in children is challenging due to the lack of definitive signs. This review examines evidence for best practices in AHT diagnosis, integrating clinical, radiological, and autopsy findings.
Area of Science:
- Pediatrics
- Forensic Pathology
- Radiology
Background:
- Abusive head trauma (AHT) is frequently misdiagnosed in pediatric cases.
- The absence of pathognomonic signs complicates AHT diagnosis.
- Accurate diagnosis of AHT presents significant medico-legal challenges.
Purpose of the Study:
- To review current scientific evidence on diagnosing abusive head trauma (AHT).
- To identify best practices for AHT diagnosis.
- To evaluate diagnostic tools for AHT in children.
Main Methods:
- Review of scientific literature on AHT diagnosis.
- Evaluation of circumstantial evidence and clinical history.
- Assessment of postmortem radiological examinations (CT, MRI).
- Analysis of autopsy findings, including ocular and brain histology.
Main Results:
- No single pathognomonic sign exists for diagnosing AHT.
- Circumstantial evidence, clinical history, and autopsy findings are crucial.
- Postmortem imaging (CT, MRI) and histological examination aid diagnosis.
- Correlation of in vivo symptoms with autopsy findings is important.
Conclusions:
- A comprehensive approach integrating multiple diagnostic modalities is essential for accurate AHT diagnosis.
- Reliable diagnostic tools are critical for addressing the medico-legal aspects of AHT.
- Histological examination of the eye and brain, correlated with clinical data, enhances diagnostic certainty.
Abstract:
Abusive head trauma (AHT) represents a commonly misdiagnosed condition. In fact, there is no pathognomonic sign that allows the diagnosis in children. Therefore, it is such an important medico-legal challenge to evaluate reliable diagnostic tools. The aim of this review is to evaluate the current scientific evidence to assess what the best practice is in order to diagnose AHT. We have focused particularly on evaluating the importance of circumstantial evidence, clinical history, the use of postmortem radiological examinations (such as CT and MRI), and the performance of the autopsy. After autopsy, histological examination of the eye and brain play an important role, with attention paid to correlation with symptoms found in vivo.
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