Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data

Independently witnessed events are used as a reference standard to robustly categorize accidental or non-abusive head trauma (non-AHT) cases in the pediBIRN data set of acutely symptomatic infants with closed head injuries. Findings in such independently witnessed non-AHT cases are compared to findings in cases that were diagnosed as AHT but were not independently witnessed. The data shows that 14% of independently witnessed non-AHT cases are misdiagnosed as AHT, and that risk factors for misdiagnosis include acute encephalopathy, bilateral or interhemispheric SDH, and/or severe retinal hemorrhages, findings that are commonly associated with AHT. The data also shows that "dense retinal hemorrhages extending to the periphery" are not highly suggestive of AHT, as they also occur in independently witnessed non-AHT cases.