What Do Confessions Reveal about Abusive Head Trauma? A Systematic Review

Abstract

Although confessions related to abusive head trauma (AHT) are reported, no detailed analysis exists. Therefore, we systematically reviewed studies of AHT confessions and examined the details, including country of origin, mechanisms and perpetrators' characteristics. Employing 36 search terms across three search engines, we searched Medline and CINAHL from 1963 to 2018. All relevant studies underwent two independent reviews and data extraction. Descriptive statistics were used to characterise the sample; chi square and Fisher's exact tests were used to assess differences in demographic and clinical characteristics. Of 6759 identified studies, 157 full texts were reviewed and 55 articles from 15 countries spanning four continents were included. Included articles contained 434 confessions. The mechanisms of abuse included shaking alone (64.1%), impact alone (17.1%), shaking plus impact (18.0%) and other (0.9%). There was no statistically significant difference in the percentage of confessions reporting shaking alone when comparing continents: North America (64.0%), Europe (64.2%) and Oceania (60.0%; p = 0.92), or when comparing circumstances in which the confession was obtained: medical evaluation (74.6%) vs police or judicial investigations (63.4%; p = 0.11). Of 119 cases with identified perpetrators, 67.2 per cent were cases with males alone. Confessions reveal striking similarities in the mechanism of AHT (predominantly shaking) that occur across the globe.Key Practitioner Messages Confessions can provide important information about AHT and have been reported in medical literature for over 40 years. The quality of evidence for the association of shaking with AHT has been questioned, but no systematic review of confessions of AHT has been performed previously. This systematic review of confessions of AHT reveals that shaking is the most common mechanism reported and that shaking and AHT occur together across the world. ‘We systematically reviewed studies of AHT confessions and examined the details, including country of origin, mechanisms and perpetrators' characteristics’

Physical abuse of young children during the COVID-19 pandemic: Alarming increase in the relative frequency of hospitalizations during the lockdown period

“…Parental mental health impairment and psychiatric disorders have been identified as factors associated with child physical abuse, which might have resulted in an increase in female perpetrators during the lockdown. This may have had an influence on the gender ratio of perpetrators, considering that previous studies have shown that male perpetrators are responsible for 60–70% of child physical abuse cases ( Edwards et al, 2020 ; Starling & Holden, 2020 ). While the increased frequency of female perpetrators might potentially be associated with an altered gender ratio of physically abused children, the finding remains rather puzzling.…”

Abusive Head Trauma through Shaking: Examination of the Perpetrators According to Dating of the Traumatic Event

“…None of these transcriptions reported that the infant had symptoms before this sudden occurrence of the LOC. This contrasts with further versions that these adults gave to police officers, where in some cases they mentioned symptoms prior to the LOC, reinforcing the frequent ‘changing history’ observed in cases of AHT (Edwards et al ., 2020).…”

“…Although infants were described as not crying habitually in this study, one cannot rule out that crying increases in the presence of an abusive adult, and crying remains a trigger that is often mentioned in AHT occurrence (Edwards et al ., 2020). In any case, it is important to give a universal simple message about the fact that a child can cry for prolonged periods without being ill, and that a baby may be abused by an exasperated adult.…”

“…Although few long‐term follow‐up studies have been published, a high percentage of infants with AHT end up with chronic developmental or neurological disabilities (Chevignard and Lind, 2014). The predominant mechanism of AHT is shaking with or without impact (Edwards et al ., 2020). Confessions have provided descriptions of shaking as an extremely violent event, repeated in more than half of the cases (Adamsbaum et al ., 2010).…”

Recognising Limitations: Pitfalls in Drawing Conclusions about Abusive Head Trauma

“…Accidental head injuries, resulting mostly from impact, and inflicted head injuries, resulting from either shaking or impact, or a combination of the two, overlap considerably (Christian, 2007; Kemp et al ., 2011). Confessions (Edwards et al ., 2020) and eyewitness accounts can help determine the mechanism of injury, but they can sometimes be false. Therefore, the determination of the mechanism of an inflicted head injury is often difficult.…”