| 1. |
- Andersson, Jacob, et al.
(författare)
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Differences in head circumference and neuroimaging characteristics : what can they tell about the aetiologies of infant subdural haematoma?
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background Acute (ASDH) and chronic subdural haematoma (CSDH) in infants have been regarded as highly specific for abuse. A recent study showed different risk factors for ASDH and CSDH, indicating that CSDH in many cases was related to external hydrocephalus. Purpose To investigate to what extent external hydrocephalus may explain findings and symptoms interpreted as signs of abusive head trauma. Material and methods Eighty-five infants with ASDH (n=16) and CSDH (n=69) were reviewed with regard to cranio-cortical- (CCW), sino-cortical- (SCW), frontal interhemispheric-(IHW), subarachnoid space width (SSW) and head circumference (HC). In infants with unilateral SDH, the correlation between the contralateral SSW and the ipsilateral CCW and SDH width was calculated. A correlation would imply that the CSDH replaces an already existing extracerebral space.Results Infants with CSDH had significantly higher CCW, SCW, IHW and SSW than infants with ASDH (p < 0.05). The ipsilateral CCW (R = 0.92, p < 0.001) and SDH width (R = 0.81, p < 0.01) were correlated to the contralateral SSW. Increased HC was more prevalent in Infants with CSDH (71%) than in infants with ASDH (14%) (p < 0.01). Forty-two infants, all with CSDH, had at least one of CCW, SCW or IHW ≥ 95th percentile. Twenty infants, all with CSDH, had CCW, SCW and IHW > 5 mm and increased HC. Conclusion A significant proportion of infants with CSDH may have external hydrocephalus as an underlying cause and that parts of the widened subarachnoid space in some infants is replaced by a CSDH.
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| 2. |
- Andersson, Jacob, et al.
(författare)
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Different vulnerability profiles in acute compared to chronic subdural haematoma amongst infants with suspected abusive head trauma
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: In a register study based on ICD 10 coding, there was a similar vulnerability profile (male sex, preterm and small for gestational age) in infants diagnosed with non-traumatic subdural haematoma (SDH) and infants having SDH with abuse diagnosis. However, ICD-10 does not separate between acute (ASDH) and chronic subdural haematoma (CSDH). Purpose: To determine the vulnerability profile in infants having CSDH and ASDH, respectively. Material and methods: A descriptive review of infants with SDH/hygroma examined by the Swedish National Board of Forensic Medicine between 1994 and 2018. Included cases (n=85) were analysed with regard to possible vulnerability factors. Results: Type of subdural fluid could be determined in 85 of 96 cases. Sixteen infants had ASDH and 69 CSDH. Infants with ASDH had the peak incidence during the first month of life, 56% were male, 6% were premature, 13% were twins and 44% died. In infants with CSDH, the peak incidence occurred during the third month of life, 69% were male, 34% were premature, 12% were twins and 4% died. Conclusion: CSDH, but not ASDH, is associated with factors suggesting non-traumatic pathogenesis, for which reason CSDH and ASDH should be analysed separately to extend the knowledge regarding the aetiology of SDH during infancy.
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| 3. |
- Andersson, Jacob, et al.
(författare)
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External Hydrocephalus as a Cause of Infant Subdural Hematoma : Epidemiological and Radiological Investigations of Infants Suspected of Being Abused
- 2022
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Ingår i: Pediatric Neurology. - : Elsevier. - 0887-8994 .- 1873-5150. ; 126, s. 26-34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acute subdural hematoma (ASDH) and chronic subdural hematoma (CSDH) in infants have been regarded as highly specific for abuse. Other causes of CSDH have not been investigated in a large population.Purpose: The purpose of this study was to investigate to what extent external hydrocephalus is present in infants with ASDH and CSDH undergoing evaluation for abuse.Material and methods: Eighty-five infants suspected of being abused, with ASDH (n = 16) or CSDH (n = 69), were reviewed regarding age, risk factor profiles, craniocortical width (CCW), sinocortical width (SCW), frontal interhemispheric width (IHW), subarachnoid space width (SSW), and head circumference (HC). In infants with unilateral subdural hematoma (SDH), correlations between contralateral SSW and ipsilateral CCW and SDH width were investigated.Results: Infants with CSDH had significantly lower mortality, were more often premature and male, and had significantly higher CCW, SCW, IHW, and SSW than infants with ASDH (P < 0.05). Ipsilateral CCW (R = 0.92, P < 0.001) and SDH width (R = 0.81, P < 0.01) correlated with contralateral SSW. Increased HC was more prevalent in infants with CSDH (71%) than in infants with ASDH (14%) (P < 0.01). Forty-two infants, all with CSDH, had at least one of CCW, SCW, or IHW ≥95th percentile. Twenty infants, all with CSDH, had CCW, SCW, and IHW >5 mm, in addition to increased HC.Conclusion: A substantial proportion of infants with CSDH who had been suspected of being abused had findings suggesting external hydrocephalus.
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| 4. |
- Stridbeck, Ulf, et al.
(författare)
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Vurdering av filleristing av barn i straffesaker for norske domstoler
- 2020
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Ingår i: Tidsskrift for rettsvitenskap. - : Scandinavian University Press / Universitetsforlaget AS. - 0040-7143 .- 1504-3096. ; 133:4, s. 423-475
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Tidskriftsartikel (refereegranskat)abstract
- Dette er en flerfaglig gjennomgang av samtlige norske straffesaker funnet på Lovdata fra 2004 fram til 2015 om «filleristing». Hver sak er gjennomgått av forfatterne; to jurister og tre medisinske eksperter på hodeskader hos barn. Materialet har bestått av straffesaksdokumentene, inkludert sakkyndige rapporter og aktuelle pasientjournaler med billeddiagnostikk av de samme barna. Rettssakene presenteres ut fra dommene, og i de aktuelle sakene er rettens vurderinger i mange saker knyttet opp mot de rettssakkyndiges vurderinger. Parallelt har de medisinske forfatterne etterprøvd hvorvidt de sakkyndiges vurderinger står seg ut fra dagens kunnskap om slike skadebilder. Særlig vekt er lagt på muligheten for at skadebildet ikke er påført ved foreldres eller andres voldsbruk, men av medisinske tilstander hos barnet selv. Det kan synes som om det er få fellende straffedommer som utelukkende er basert på sakkyndighetsvurderinger vedrørende filleristing. I flere andre saker synes det å foreligge tvil når det gjelder skadeårsak og skadepåføring. I tillegg presenteres enkelte barnevernssaker med vekt på beviskravet ved filleristing sammenliknet med straffesakene, men her uten å ha foretatt nye medisinske vurderinger.
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| 5. |
- Thiblin, Ingemar, et al.
(författare)
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Medical findings and symptoms in infants exposed to witnessed or admitted abusive shaking : A nationwide registry study
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 15:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many physicians regard the combination of encephalopathy, subdural haemorrhage (SDH), retinal haemorrhage (RH), rib fractures, and classical metaphyseal lesions (CML) as highly specific for abusive head trauma (AHT). However, without observed abuse or other criteria that are independent of these findings, bias risk is high.Methods: Infants subjected for examination under the suspicion of maltreatment during the period 1997-2014 were identified in the National Patient Registry, International Classification of Diseases (ICD-10 SE). The medical records were scrutinized for identification of cases of witnessed or admitted physical abuse by shaking. The main outcome measures were occurrence of SDH, RH, fractures and skin lesions.Results: All identified 36 infants had been shaken, and for 6, there was information indicating blunt force impact immediately after shaking. In 30 cases, there were no findings of SDH or RH, rib fractures, or CMLs. Six infants had finding(s) suggestive of physical abuse, two with possible acute intracranial pathology. One infant with combined shaking and impact trauma had hyperdense SDH, hyperdense subarachnoid haemorrhage, suspected cortical vein thrombosis, RH, and bruises. Another infant abused by shaking had solely an acute subarachnoid haemorrhage. Both had pre-existing vulnerability. The first was born preterm and had non-specific frontal subcortical changes. The other had bilateral chronic SDH/hygroma.Conclusions: The present findings do not support the hypothesis that acute SDH or RH can be caused by isolated shaking of a healthy infant. However, they do suggest that abuse by shaking may cause acute intracranial haemorrhage with RH in infants with certain risk factors.
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| 6. |
- Wester, Knut, et al.
(författare)
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Re-evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses
- 2022
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:4, s. 779-792
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The criteria for diagnosing abusive head trauma (AHT) are not well defined and this condition might be diagnosed on failing premises. Our aim was to review criminal AHT cases in Norwegian courts by scrutinising the underlying medical documentation.METHODS: Cases were identified in the data registry for Norwegian courts from 2004 to 2015. Documentation was obtained from relevant health institutions. The medical co-authors first made independent evaluations of the documentation for each child, followed by a consensus evaluation.RESULTS: A total of 17 children (11 boys) were identified, all diagnosed as AHT by court appointed experts, 15 were infants (mean age 2.6 months). A high proportion (41.2%) was born to immigrant parents and 31.3% were premature. The medical findings could be explained by alternative diagnoses in 16 of the 17 children; 8 boys (7 infants - mean age 2.9 months) had clinical and radiological characteristics compatible with external hydrocephalus complicated by chronic subdural haematoma. Six children (five infants with mean age 2.1 months) had a female preponderance and findings compatible with hypoxic ischaemic insults.CONCLUSION: The medical condition in most children had not necessarily been caused by shaking or direct impact, as was originally concluded by the court experts.
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