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Confessed versus denied inflicted head injuries in infants: similarities and differences
Matthieu Vinchon1, Mélodie-Anne Karnoub2, Nathalie Noulé3
1Department of Pediatric Neurosurgery, Lille University Hospital, Lille, France. mvinchon@yahoo.fr.
Insights
This study confirms abusive head injuries (AHI) are robustly diagnosed, with confessions correlating to injury severity. Denial may be ill-founded, influenced by lesion severity in infant trauma cases.
Area of Science:
- Pediatrics
- Forensic Medicine
- Neurology
Background:
- Abusive head injuries (AHI), including shaken baby syndrome (SBS), are significant causes of infant mortality and morbidity.
- While SBS is established, recent literature questions diagnostic criteria and confession validity.
Purpose of the Study:
- To investigate abusive head injuries (AHI) in infants.
- To compare AHI cases with and without perpetrator confessions.
Main Methods:
- Prospective collection of infantile traumatic head injury cases (2001-2021).
- Comparison of AHI victims with confessions versus those without during police inquiry.
- Analysis of clinical presentation, lesions, and outcomes.
Main Results:
- 350 AHI cases studied; 137 (39.1%) involved confessions.
- No significant differences in child or caretaker history between groups.
- Confession group exhibited more severe clinical presentation, cerebral lesions, retinal hemorrhages, and poorer outcomes.
Conclusions:
- Confessions validate AHI diagnostic criteria, suggesting robustness.
- Denial, while potentially sincere, may be unfounded.
- Perpetrator confession or denial is influenced by inflicted lesion severity.
Background And Purpose:
Abusive head injuries (AHI), and in particular shaken baby syndrome (SBS), are common causes of mortality and morbidity in infants. Although SBS is a well-established entity, based on clinical experience and experimental data, and confirmed by the perpetrators' confessions, a growing number of publications challenge the diagnostic criteria, and even the validity of the perpetrators' confession. We decided to study AHI in infants and compare cases with and without confession.
Material And Methods:
We collected prospectively all cases of infantile traumatic head injuries hospitalized in our institution between 2001 and 2021. From this database, we selected victims of AHI, comparing cases for which the perpetrator confessed during police inquiry ("confession" group) versus cases without confession ("denial" group).
Results:
We studied 350 cases of AHI in infants; 137 of these (39.1%) were confessed. We found no statistically significant difference between the two groups regarding the child's previous history, as well as the personality and previous history of the caretakers. However, the "confession" group showed significantly more severe clinical presentation, cerebral lesions, retinal hemorrhages, and a more pejorative outcome.
Conclusions:
We conclude that the diagnosis of AHI was confirmed by the confession in a large number of cases, indicating that the diagnostic criteria of AHI are robust. We also found that denial, although possibly sincere, was likely ill-founded, and that the perpetrators' decision to confess or deny was markedly influenced by the severity of the inflicted lesions.
