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Guidance for a clinical and forensic diagnosis of pediatric abusive head trauma: a narrative review
Monica Concato1, Anita Galic Mihic2, Tijana Petrovic3
1Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Insights
Abusive head trauma (AHT), formerly Shaken Baby Syndrome, requires thorough forensic evaluation. Autopsies are crucial for diagnosis, necessitating standardized methods to ensure accurate conclusions in child abuse investigations.
Area of Science:
- Forensic Pathology
- Pediatric Medicine
- Legal Medicine
Background:
- Abusive head trauma (AHT), previously known as Shaken Baby Syndrome, presents diagnostic challenges in forensic investigations.
- Accurate assessment requires comprehensive medical history, clinical examination, and diagnostic tests.
- Autopsy is a critical step in investigating fatal AHT cases, demanding expertise.
Purpose of the Study:
- To compile methodological updates in the last decade for abusive head trauma (AHT) diagnosis.
- To promote uniformity in medico-legal practices concerning AHT investigations.
- To reduce the risk of erroneous conclusions in child abuse cases.
Main Methods:
- Review of instrumental examinations and autopsy findings.
- Macroscopic and histological assessment of injuries.
- Synthesis of methodological advancements in AHT forensic pathology.
Main Results:
- Autopsy, including macroscopic and histological evaluation, is essential for AHT diagnosis.
- Standardized methodologies are vital for accurate interpretation of findings.
- Recent updates aim to enhance consistency in forensic assessments.
Conclusions:
- Standardized autopsy protocols are crucial for reliable abusive head trauma (AHT) diagnosis.
- Methodological updates are necessary to improve forensic practice and patient outcomes.
- Consistent medico-legal approaches ensure justice and protect child welfare.
Abstract:
The term Shaken Baby Syndrome, now largely replaced by the more general term abusive head trauma (AHT), poses significant challenges for forensic assessment and investigation. The clinical assessment of these cases remains a complex process that necessarily involves collecting a complete medical history, taking into account the caregivers and the child's socio-economic and family context, a thorough physical examination, and additional diagnostic investigations. In cases where the child has died, the autopsy-whether performed for investigative or purely diagnostic purposes-remains an essential step requiring a rigorous methodological approach, technical expertise, and in-depth knowledge of the subject. Guided by previously conducted instrumental examinations, the autopsy includes a fundamental macroscopic evaluation followed by the essential histological assessment of the injuries. Given the importance of the topic, and the implications of an erroneous conclusion for both the young patient and their family, this work aims to compile methodological updates from the last ten years, in order to promote greater uniformity in the medico-legal practice.
