Data‐driven evidence shows truthful caregiver histories and significant overdiagnosis of abusive head trauma

Abstract

ObjectiveWe analyzed the veracity of caregiver‐provided histories when infants present with intracranial pathologies and abusive head trauma (AHT) is suspected.MethodsA comparison of medical findings is made using data from 335 infants with acute intracranial pathologies and no extracranial findings associated with abuse. Two null hypotheses were tested: (1) that cases where caregivers reported accidental trauma have similar medical findings to independently witnessed accidents; and (2) that cases where caregivers reported no trauma have similar medical findings as cases where caregivers reported accidental trauma.ResultsThe first null hypothesis is not rejected, corroborating caregiver histories of accidental trauma, yet such cases are diagnosed as AHT at significantly higher rates than accidents witnessed by unbiased independent observers. The second null hypothesis is rejected, corroborating caregiver histories that no trauma occurred.ConclusionsData suggest that caregivers can provide valuable diagnostic information when infants present with acute intracranial pathologies and suggest substantial rates of misdiagnosis of AHT.

Retino‐dural hemorrhages in infants are markers of degree of intracranial pathology, not of violent shaking

“…17,18 The statistical similarities presented in Table 1 between the categories of witnessed accidents and reported accidents have also been documented and have recently been interpreted as corroborating evidence that caregivers are generally telling the truth when they report a traumatic accident. 19 However, when comparing clinical findings across different categories of cases, it is crucial to carefully consider the methods employed for case selection within each category. The scrutiny of selection methods ensures that any comparisons drawn are equitable and unbiased.…”