Citation

Fleming P, Byard RW. Acta Paediatr. 2018; 107(3): 382-383.

Affiliation

The University of Adelaide, Adelaide, SA, Australia.

Comment On:

Acta Paediatr 2018;107(3):477-483.

Copyright

(Copyright © 2018, John Wiley and Sons)

DOI

10.1111/apa.14185

PMID

29280515

Abstract

The designation ‘abusive head trauma’ (AHT) is the term preferred by the American Academy of Pediatrics for infants who have suffered intracranial injury caused by blunt trauma or violent shaking 1. It has been suggested, however, that a more general term, such as ‘blunt craniocerebral trauma’, may be preferable initially as this does not imply intent.

The diagnosis of AHT has commonly been based upon the presence of subdural haemorrhage, with or without retinal haemorrhage and/or encephalopathy – the so‐called triad. The significance of the ‘triad’ has however been called into question, and, whilst it is commonly perceived as being suggestive of a preceding episode of shaking, or shaking plus impact, it is now widely recognised that this combination of findings is certainly not pathognomonic for abusive head injury 2. The use of this term remains controversial and a recent systematic review conducted by the Swedish Agency for Health Technology Assessment 3 concluded that ‘there is limited scientific evidence that the triad and therefore its components can be associated with traumatic shaking’. This systematic review has however been strongly criticised and major methodological flaws have been described 2, most importantly pointing out the limitation of the study to the so‐called triad, rather than to subdural haemorrhage with or without other signs of possible abuse.

It is now clear that the presence of subdural haemorrhage in asymptomatic newborn infants is common ...

Language: en