title: Abusive head trauma: differentiation between impact and non-impact cases based on neuroimaging findings and skeletal surveys.
abstract: OBJECTIVE
  To determine whether imaging findings can be used to differentiate between impact and non-impact head trauma in a group of fatal and non-fatal abusive head trauma (AHT) victims.
  
  
  METHODS
  We included all AHT cases in the Netherlands in the period 2005-2012 for which a forensic report was written for a court of law, and for which imaging was available for reassessment. Neuroradiological and musculoskeletal findings were scored by an experienced paediatric radiologist.
  
  
  RESULTS
  We identified 124 AHT cases; data for 104 cases (84%) were available for radiological reassessment. The AHT victims with a skull fracture had fewer hypoxic ischaemic injuries than AHT victims without a skull fracture (p=0.03), but the relative difference was small (33% vs. 57%). There were no significant differences in neuroradiological and musculoskeletal findings between impact and non-impact head trauma cases if the distinction between impact and non-impact head trauma was based on visible head injuries, as determined by clinical examination, as well as on the presence of skull fractures.
  
  
  CONCLUSIONS
  Neuroradiological and skeletal findings cannot discriminate between impact and non-impact head trauma in abusive head trauma victims.
authors.affiliation: Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: t.sieswerda@amc.nl.
authors.forename: T
authors.initials: T
authors.lastname: Sieswerda-Hoogendoorn
authors.affiliation: Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: s.robben@maastrichtuniversity.nl.
authors.forename: S G F
authors.initials: SG
authors.lastname: Robben
authors.affiliation: Department of Forensic Medicine, Netherlands Forensic Institute, P.O. Box 24044, 2490 AA The Hague, The Netherlands. Electronic address: w.karst@nfi.minvenj.nl.
authors.forename: W A
authors.initials: WA
authors.lastname: Karst
authors.affiliation: Faculty of Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: f.moesker@erasmusmc.nl.
authors.forename: F M
authors.initials: FM
authors.lastname: Moesker
authors.affiliation: Department of Paediatrics, Academic Medical Center/Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: w.m.vanaalderen@amc.nl.
authors.forename: W M
authors.initials: WM
authors.lastname: van Aalderen
authors.affiliation: Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: j.s.lameris@amc.nl.
authors.forename: J S
authors.initials: JS
authors.lastname: Laméris
authors.affiliation: Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: r.r.vanrijn@amc.nl.
authors.forename: R R
authors.initials: RR
authors.lastname: van Rijn
mesh_terms: D017677:Age Distribution; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology; D015984:Causality; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis* / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D059906:Neuroimaging / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D018434:Sickness Impact Profile; D012887:Skull Fractures / Q000175:diagnosis* / Q000453:epidemiology
keywords: Abusive head trauma; Child abuse; Forensic medicine; Haematoma, subdural; Head injury, closed