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      The impact of the consensus statement on abusive head trauma in infants and young children

      review-article
      Pediatric Radiology
      Springer Berlin Heidelberg
      Abusive head trauma, Child abuse, Consensus statement, Imaging, Infants

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          Abstract

          It seems paradoxical that facts, data and science are still considered controversial despite the harrowing death of a multitude of people from coronavirus disease 2019 (COVID-19), an unparalleled health care crisis of our lifetime. In addition, while scientists are desperately attempting to produce a vaccine for COVID-19, a large segment of the populace still believes in conspiracies related to vaccines. Therefore, it is not surprising that the diagnosis of abusive head trauma (AHT) faces similar challenges — the difference being that AHT challenges are mostly in the realms of law courts rather than actual clinical management of these infants. Against this backdrop, the Child Abuse Imaging Committee of the Society for Pediatric Radiology (SPR) collaborated with other leading experts to develop the consensus statement on AHT. This consensus statement has had a significant impact since its publication. It is now endorsed by 17 multinational, multidisciplinary organizations. The consensus statement has helped educate the diverse stakeholders of AHT and has helped further our understanding of AHT and the issues related to it. This could serve as the template for developing future consensus documents.

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          Most cited references11

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          RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children

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            Wakefield's article linking MMR vaccine and autism was fraudulent

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              Consensus statement on abusive head trauma in infants and young children

              Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.
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                Author and article information

                Contributors
                achoudhary@uams.edu
                Journal
                Pediatr Radiol
                Pediatr Radiol
                Pediatric Radiology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0301-0449
                1432-1998
                17 May 2021
                2021
                : 51
                : 6
                : 1076-1078
                Affiliations
                GRID grid.241054.6, ISNI 0000 0004 4687 1637, Department of Radiology, , University of Arkansas for Medical Sciences (UAMS), ; 4301 W. Markham St., Slot 556, Little Rock, AR 72205 USA
                Author information
                http://orcid.org/0000-0002-2338-5906
                Article
                4949
                10.1007/s00247-020-04949-x
                8126591
                33999248
                f67ef5c9-8c28-4041-ba4b-b398091f1ea6
                © The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 18 August 2020
                : 9 November 2020
                : 16 December 2020
                Categories
                Child Abuse Imaging
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                Pediatrics
                abusive head trauma,child abuse,consensus statement,imaging,infants
                Pediatrics
                abusive head trauma, child abuse, consensus statement, imaging, infants

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