Letter to the Editor

Implications of Occult Cranial Injuries for Perpetrator Identification in Cases of Alleged Abusive Head Trauma

Authors: John G. Galaznik, MD, FAAP

Abstract

To the Editor:


After reading the recent article in the Southern Medical Journal, “Occult Cranial Injuries Found with Neuroimaging in Clinically Asymptomatic Young Children Due to Abusive Compared to Accidental Head Trauma” by Fickenscher et al1 and the accompanying editorial comments by Dr. Block2 and Drs. Waseem and Zipin,3 I agree that this article is significant. However, for me one major implication of this work was not addressed by the article or the accompanying commentaries – its impact on our understanding of the determination of the timing of injury. Given that these cases often lead to family court hearings and criminal prosecutions, it is vital to not only identify abuse, but to accurately identify the perpetrator of abuse.

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References

1.Fickenscher KA, Dean JS, Mena DC, et al. Occult cranial injures found with neuroimaging in clinically asymptomatic young children due to abusive compared to accidental head trauma. South Med J 2010;103:121–125.
 
2.Block RW. Neuroimaging for children presenting with head trauma. South Med J 2010;103:107.
 
3.Waseem M, Zipin K. Imaging in asymptomatic children after trauma? South Med J 2010;103:108.
 
4.Section on Radiology; American Academy of Pediatrics. Diagnostic imaging of child abuse. Pediatrics 2009;123:1430–1435.
 
5.Duhaime AC, Christian CW, Rorke LB, et al. Nonaccidental head injury in infants—the “shaken-baby syndrome.” New Engl J Med 1998;338:1822–1829.
 
6.American Academy of Pediatrics: Committee on Child Abuse and Neglect. Shaken baby syndrome: rotational cranial injuries—technical report. Pediatrics 2001;108:206–210.
 
7.Case ME, Graham MA, Handy TC, et al; National Association of Medical Examiners Ad Hoc Committee on Shaken Baby Syndrome. Position paper on fatal abusive head injuries in infants and young children. Am J Forensic Med Pathol 2001;22:112–122.