ArticleChild abuse & neglect2022
An analysis of physicians' diagnostic reasoning regarding pediatric abusive head trauma.
Article in Child abuse & neglect, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Abusive head trauma in children under 2 years of age in Latin America: a systematic review.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Pooled it
- Medical findings in young patients with head trauma: How strong is the evidence for abuse?International journal of legal medicine · 2026Article
- AHT diagnoses: The influences of clinical presentation and evidence of impact.Child abuse & neglect · 2026Article
- A critical review of the American Academy of Pediatrics technical report on abusive head trauma.Forensic science international. Synergy · 2025Review
- Commentary on Witnessing Abusive Head Trauma: Accidents Show Higher Rates of Intracranial Pathologies Than Shaking-Caution Is Warranted.Annals of the Child Neurology Society · 2025Article
- Policy critique: The conflation of shaken baby syndrome and abusive head trauma - a measure with several negative effects.Forensic science international. Synergy · 2025Article
- Witnessing abusive head trauma: Accidents show higher rates of intracranial pathologies than shaking.Annals of the Child Neurology Society · 2024Article
- Retino-dural hemorrhages in infants are markers of degree of intracranial pathology, not of violent shaking.Annals of the Child Neurology Society · 2024Article
- An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse.Children (Basel, Switzerland) · 2024Review
- Why admitted cases of AHT make a low quality reference standard: A survey of people accused of AHT in France.Forensic science international. Synergy · 2023Article
- Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data.Forensic science international. Synergy · 2023Article
Corrections and comments
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Authors and funding
13 authors at 11 institutions in 1 country.
Funding
Abstract
backgroundPhysician diagnoses of abusive head trauma (AHT) have been criticized for circular reasoning and over-reliance on a "triad" of findings. Absent a gold standard, analyses that apply restrictive reference standards for AHT and non-AHT could serve to confirm or refute these criticisms.
objectivesTo compare clinical presentations and injuries in patients with witnessed/admitted AHT vs. witnessed non-AHT, and with witnessed/admitted AHT vs. physician diagnosed AHT not witnessed/admitted. To measure the triad's AHT test performance in patients with witnessed/admitted AHT vs. witnessed non-AHT. PARTICIPANTS AND
settingAcutely head injured patients <3 years hospitalized for intensive care across 18 sites between 2010 and 2021.
methodsSecondary analyses of existing, combined, cross-sectional datasets. Probability values and odds ratios were used to identify and characterize differences. Test performance measures included sensitivity, specificity, and predictive values.
resultsCompared to patients with witnessed non-AHT (n = 100), patients with witnessed/admitted AHT (n = 58) presented more frequently with respiratory compromise (OR 2.94, 95% CI: 1.50-5.75); prolonged encephalopathy (OR 5.23, 95% CI: 2.51-10.89); torso, ear, or neck bruising (OR 11.87, 95% CI: 4.48-31.48); bilateral subdural hemorrhages (OR 8.21, 95% CI: 3.94-17.13); diffuse brain hypoxia, ischemia, or swelling (OR 6.51, 95% CI: 3.06-13.02); and dense, extensive retinal hemorrhages (OR 7.59, 95% CI: 2.85-20.25). All differences were statistically significant (p ≤ .001). No significant differences were observed in patients with witnessed/admitted AHT (n = 58) vs. patients diagnosed with AHT not witnessed/admitted (n = 438). The triad demonstrated AHT specificity and positive predictive value ≥0.96.
conclusionsThe observed differences in patients with witnessed/admitted AHT vs. witnessed non-AHT substantiate prior reports. The complete absence of differences in patients with witnessed/admitted AHT vs. physician diagnosed AHT not witnessed/admitted supports an impression that physicians apply diagnostic reasoning informed by knowledge of previously reported injury patterns. Concern for abuse is justified in patients who present with "the triad."
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