A Daubert Analysis of Abusive Head Trauma/Shaken Baby Syndrome

Narang, Sandeep K.

doi:10.2139/ssrn.1919054

Cited by 17 publications

(24 citation statements)

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“…Yet given the backlash physicians may face 15 and expectations that those testifying in the courts must be able to support their opinions with scientific evidence, 16,17 consolidating the scientific evidence into decisionmaking is paramount.…”

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confidence: 99%

Validation of a Prediction Tool for Abusive Head Trauma

et al. 2015

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BACKGROUND AND OBJECTIVES: Abusive head trauma (AHT) may be missed in the clinical setting. Clinical prediction tools are used to reduce variability in practice and inform decision-making. From a systematic review and individual patient data analysis we derived the Predicting Abusive Head Trauma (PredAHT) tool, using multilevel logistic regression to predict likelihood of AHT. This study aims to externally validate the PredAHT tool.METHODS: Consecutive children aged ,36 months admitted with an intracranial injury, confirmed as abusive or nonabusive, to 2 sites used in the original model were ascertained. Details of 6 influential features were recorded (retinal hemorrhage, rib and long -bone fractures, apnea, seizures, and head or neck bruising). We estimated the likelihood of an unrecorded feature being present with multiple imputation; analysis included sensitivity, specificity, and area under the curve, with 95% confidence intervals (CIs).RESULTS: Data included 133 non-AHT cases and 65 AHT cases, 97% of children were ,24 months old. Consistent with original predictions, when $3 features were present in a child ,36 months old with intracranial injury, the estimated probability of AHT was .81.5% (95% CI, 63.3-91.8). The sensitivity of the tool was 72.3% (95% CI, 60.4-81.7), the specificity was 85.7% (95% CI, 78.8-90.7), area under the curve 0.88 (95% CI, 0.823-0.926).CONCLUSIONS: When tested on novel data, the PredAHT tool performed well. This tool has the potential to contribute to decision-making in these challenging cases. An implementation study is needed to explore its performance and utility within the child protection process. WHAT'S KNOWN ON THIS SUBJECT:A previous multivariable statistical model, using individual patient data, estimated the probability of abusive head trauma based on the presence or absence of 6 clinical features: rib fracture, long-bone fracture, apnea, seizures, retinal hemorrhage, and head or neck bruising. WHAT THIS STUDY ADDS:The model performed well in this validation, with a sensitivity of 72.3%, specificity of 85.7%, and area under the curve of 0.88. In children ,3 years old with intracranial injury plus $3 features, the estimated probability of abuse is .81.5%. Ms Cowley drafted the Methods section, produced the tables, revised the article, formatted the article, and contributed to overall editing; Dr Morris collected the data in data set 1 and entered all anonymized data into the database; Dr. Maguire had the initial study idea, drafted and revised the article, and contributed to the study design and overall editing; Dr Farewell designed and conducted all statistical analyses, drafted the statistical components of the article, produced the figures, and contributed to overall editing; Prof Kemp revised the article and contributed to overall study design and editing; and all authors approved the final manuscript as submitted. Clinicians who undertake child protection investigations of children presenting with head injury can meet resistance and face a barrage of critici...

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Validation of a Prediction Tool for Abusive Head Trauma

et al. 2015

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“…. or single case reports," which together support his conclusion that AHT/SBS is a clinically valid medical diagnosis [28]. Dr. Narang also provides medical experts and courts with an exceptionally clear and useful review of the basic statistical tools necessary to assess the accuracy of increasingly common arguments that the scientific underpinnings of AHT/SBS are flawed because they are "predicated upon 'circular reasoning,' 'data gaps,' and 'inconsistency of case definition,' and that 'as technology and scientific methodology advanced, researchers questioning the basis of SBS reached a critical mass'" [28].…”

Section: How Daubert Can Help the Pediatric Healthcare Expertmentioning

confidence: 72%

“…The specific question of whether medical evidence of AHT/ SBS meets the Daubert standard has recently been addressed by Dr. Sandeep Narang in his article, "A Daubert Analysis of Abusive Head Trauma/Shaken Baby Syndrome" [28]. Dr. Narang applies Daubert criteria to the medical literature used to support (and critique) the validity of AHT/SBS and to clinical diagnostic practice.…”

Section: How Daubert Can Help the Pediatric Healthcare Expertmentioning

confidence: 99%

What do pediatric healthcare experts really need to know about Daubert and the rules of evidence?

Moreno

2012

Pediatr Radiol

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“…29 Similar concerns have pervaded the child maltreatment arena. 30 Child maltreatment cases, whether adjudicated in the civil or criminal realm, can be emotionally charged cases. In some circumstances, pediatricians have forged strong relationships with their patient families.…”

Section: Legal and Ethical Standards Of Testimonymentioning

confidence: 99%

Expert Witness Participation in Civil and Criminal Proceedings

Paul

Narang

2017

Pediatrics

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The interests of the public and both the medical and legal professions are best served when scientifically sound and unbiased expert witness testimony is readily available in civil and criminal proceedings. As members of the medical community, patient advocates, and private citizens, pediatricians have ethical and professional obligations to assist in the civil and criminal judicial processes. This technical report explains how the role of the expert witness differs in civil and criminal proceedings, legal and ethical standards for expert witnesses, and strategies that have been employed to deter unscientific and irresponsible testimony. A companion policy statement offers recommendations on advocacy, education, research, qualifications, standards, and ethical business practices all aimed at improving expert testimony.

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A Daubert Analysis of Abusive Head Trauma/Shaken Baby Syndrome

Cited by 17 publications

References 0 publications

Validation of a Prediction Tool for Abusive Head Trauma

Validation of a Prediction Tool for Abusive Head Trauma

What do pediatric healthcare experts really need to know about Daubert and the rules of evidence?

Expert Witness Participation in Civil and Criminal Proceedings

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