ArticleInternational journal of legal medicine2026
Medical findings in young patients with head trauma: How strong is the evidence for abuse?
Article in International journal of legal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectiveA Likelihood ratio (LR) is a numerical measure of evidential value. Our objective was to use LRs to express the patient-specific evidential values of medical findings that best differentiate abusive versus non-abusive head trauma (AHT). We hypothesized that the evidential values of patients' AHT-related medical findings would be highly variable.
methodsWe analyzed existing, uniform, prospective, de-identified data regarding 973 acutely head-injured children < 3 years hospitalized for intensive care across 18 sites between 2011 and 2021; applied two different proxies for AHT and non-AHT ground truth; trained and validated statistical models that differentiate AHT versus non-AHT; and analyzed patient-specific LRs in a log
resultsThe two best performing statistical models revealed evidential (LLR) values for patient-specific, AHT-related medical findings that varied from modest (-1 to + 1) to relatively large (-2.5 to -1 and + 1 to + 3.5), and values that were misleading (AHT patients with LLR values indicative of non-AHT, and vice versa). A few non-AHT patients presented with misleading evidence that was moderately strong, with LLRs approaching + 3.
conclusionsReasonable medical certainty of AHT and non-AHT can be enhanced or limited by the highly variable evidential values of patients' most discriminating medical findings. Physicians can use available LRs to inform their AHT-related diagnostic reasoning, opinions, and testimony.
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