Injury biomechanics for aiding in the diagnosis of abusive head trauma.
Much of what is understood as potential for injury is based in what has been observed clinically. This knowledge base is critical for decision making but has inherent and important limitations. Experimental studies investigating the influence of environmental factors, such as height of fall and surface type on injury potential, add important information, but also have inherent limitations. Important trends and predictions of probable injury can be studied but inference to a specific child's injuries is difficult because of unaccounted for contributing factors of injury risk. Such factors include muscle contraction, protective reflexes, and specific tissue response to trauma forces. Additional biomechanical research is needed to bridge the gap between clinical observations and experimental predictions. The specific and unique perspective of the neurosurgeon is a critical piece in differentiating accidental and nonaccidental head injury with experience and reason as the basis of the conclusion. Do the physics of the injury match the mechanistic principals of the described injury event? Could all of the injuries result from the event? Is it plausible that these set of injuries occurred from the described event based on the [table: see text] physician's experience and the current scientific understanding of injury biomechanics? Do the mechanical forces of the reported mechanism and injuries match? To determine that an explanation is plausible requires consideration of all the facts and injuries, consideration of the described behavior, and consistency with the neurologic status. These facts of the case are compared with medical knowledge and the learned experience of the neurosurgeon. The answer to the question "is it possible?" is based on clinical experience and objective reasoning. Rather than a black box question and answer based in unrealistic probability, the answer is based on the facts of the case and physical principles that govern biomechanics and resultant injuries.
Pierce
Mary Clyde
MC
Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. piercem@chplink.chp.edu
Bertocci
Gina E
GE
Berger
Rachel
R
Vogeley
Ev
E
D001696:Biomechanical Phenomena; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007223:Infant