Overturned abusive head trauma and shaken baby syndrome convictions in the United States: Prevalence, legal basis, and medical evidence

An estimated 3.6 million reports of possible child abuse or neglect, also known as nonaccidental trauma (NAT) or nonaccidental injury, involving approximately 6.6 million children were made to child protective services in the United States in 2014. The annual societal cost of child abuse and neglect is estimated conservatively to be over $103 billion. Understanding the history and physical findings specific to NAT will allow physicians to identify those children at risk and avoid missed injuries and recurrent child abuse. Bruising in particular is a cardinal physical finding for NAT. Certain diagnostic tools, such as skeletal surveys and retinal examinations, are used in evaluating for NAT. Abusive head trauma is the most common and deadliest injury. Although less common, abdominal injuries have a high mortality due to nonspecific symptoms and delayed presentation. Solid-organ abdominal injuries and duodenal hematomas can be managed nonoperatively, with a low failure rate. Up to 25% of skeletal fractures for children less than 1 year old are due to NAT. Tools to help medical personnel identify NAT are vitally important because children with recurrent NAT have a higher mortality compared with those identified at the initial episode. In Europe and the United States, checklists and algorithms have been established to standardize management of children with NAT. NAT carries significant morbidity, mortality, and cost to families and hospital resources. The key to prevention is early identification of children with NAT and early involvement of general or pediatric surgeons. Key words: abusive head trauma, ATOMAC guidelines, bruising, child abuse, children, nonaccidental injury, nonaccidental trauma, pediatric surgery, skeletal survey

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The Medical Cost of Abusive Head Trauma in the United States

PEDIATRICS ◽

10.1542/peds.2014-0117d ◽

2014 ◽

Vol 134 (1) ◽

pp. X10-X10

Keyword(s):

United States ◽

Head Trauma ◽

Medical Cost ◽

Abusive Head Trauma ◽

The United States

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Signs of Abuse

10.2310/7ccsp.8138 ◽

2017 ◽

Author(s):

Richard Sola Jr ◽

David Juang

Keyword(s):

United States ◽

Child Abuse ◽

Head Trauma ◽

Abusive Head Trauma ◽

The United States ◽

Solid Organ ◽

Delayed Presentation ◽

Abdominal Injuries ◽

Nonaccidental Trauma ◽

Nonaccidental Injury

An estimated 3.6 million reports of possible child abuse or neglect, also known as nonaccidental trauma (NAT) or nonaccidental injury, involving approximately 6.6 million children were made to child protective services in the United States in 2014. The annual societal cost of child abuse and neglect is estimated conservatively to be over $103 billion. Understanding the history and physical findings specific to NAT will allow physicians to identify those children at risk and avoid missed injuries and recurrent child abuse. Bruising in particular is a cardinal physical finding for NAT. Certain diagnostic tools, such as skeletal surveys and retinal examinations, are used in evaluating for NAT. Abusive head trauma is the most common and deadliest injury. Although less common, abdominal injuries have a high mortality due to nonspecific symptoms and delayed presentation. Solid-organ abdominal injuries and duodenal hematomas can be managed nonoperatively, with a low failure rate. Up to 25% of skeletal fractures for children less than 1 year old are due to NAT. Tools to help medical personnel identify NAT are vitally important because children with recurrent NAT have a higher mortality compared with those identified at the initial episode. In Europe and the United States, checklists and algorithms have been established to standardize management of children with NAT. NAT carries significant morbidity, mortality, and cost to families and hospital resources. The key to prevention is early identification of children with NAT and early involvement of general or pediatric surgeons. Key words: abusive head trauma, ATOMAC guidelines, bruising, child abuse, children, nonaccidental injury, nonaccidental trauma, pediatric surgery, skeletal survey

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Law enforcement investigation of non-sexual child abuse: Physical abuse, neglect and Abusive Head Trauma

The International Journal of Evidence & Proof ◽

10.1177/13657127211002284 ◽

2021 ◽

Vol 25 (2) ◽

pp. 75-92

Author(s):

Sarah Shaffer ◽

Nadja Schreiber Compo ◽

J Zoe Klemfuss ◽

Joanna Peplak ◽

Julio Mejias

Keyword(s):

Law Enforcement ◽

Physical Abuse ◽

Head Trauma ◽

Abusive Head Trauma ◽

The United States ◽

Self Control ◽

Future Research ◽

Medical Diagnoses ◽

Interviewing Techniques ◽

Case Characteristics

This study examined the experiences of law enforcement in investigating physical abuse, neglect and Abusive Head Trauma (AHT). Law enforcement ( N = 388) in the United States were surveyed regarding case characteristics, investigative strategy, interrogative approaches, frequency/content of perpetrator admissions and interagency interaction across cases of physical abuse, neglect and AHT. Results revealed that exposure rates matched those of national statistics. AHT perpetrators reported to admit guilt less often than suspects of physical abuse and neglect. Participants reported that suspects explain physical abuse and AHT by referencing poor self-control as a common cause. Lack of financial resources was commonly reported as the explanation for neglect. Potentially coercive interviewing techniques were reported across abuse types but were more frequent in cases of AHT. AHT cases were reportedly hardest to prove/prosecute partially due to conflicting medical diagnoses. Potential implications for law enforcement investigative (interviewing) policies and future research are discussed.

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Re‐evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses

Acta Paediatrica ◽

10.1111/apa.15956 ◽

2021 ◽

Author(s):

Knut Wester ◽

Ulf Stridbeck ◽

Aslak Syse ◽

Johan Wikström

Keyword(s):

Head Trauma ◽

Shaken Baby Syndrome ◽

Abusive Head Trauma

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Legal basis of «democracy»

Development of legal systems in Russia and foreign countries: problems of theory and practice ◽

10.29039/02061-6-219-227 ◽

2021 ◽

Author(s):

Sergey Polischuk

Keyword(s):

United States ◽

The United States ◽

Bill Of Rights ◽

Legal Basis ◽

Founding Fathers ◽

Political Events ◽

Capitol Hill ◽

The Us ◽

Us Constitution ◽

Election Results

The article examines the main political events that took place in the United States from the controversial election results to the tragic events on Capitol Hill for Trump supporters, which led to human casualties, finally untied the hands of the Democrats and allowed them to bury all the democratic values that America has taught the whole world since the adoption of the US Constitution and the Bill of Rights by the founding fathers of the state.

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Abusive Head Trauma: The Relationship of Perpetrators to Their Victims

PEDIATRICS ◽

10.1542/peds.95.2.259 ◽

1995 ◽

Vol 95 (2) ◽

pp. 259-262 ◽

Cited By ~ 4

Author(s):

Suzanne P. Starling ◽

James R. Holden ◽

Carole Jenny

Keyword(s):

Head Trauma ◽

Significant Proportion ◽

Shaken Baby Syndrome ◽

Abusive Head Trauma ◽

Male Victims ◽

Effective Prevention ◽

Physically Abused ◽

Female Baby ◽

Relationship Of ◽

The Relationship

Objective. Abusive head trauma is the most common cause of morbidity and mortality in physically abused infants. Effective prevention requires the identification of potential perpetrators. No study has specifically addressed the relationship of the perpetrators of abusive head trauma ("shaken baby syndrome") to their victims. The objectives of this study were to identify the abusers and their relationship to victims in these cases. Methods. We reviewed the medical charts of 151 infants who suffered abusive head trauma to determine the perpetrator of the abuse. Caretakers were classified by level of certainty: confession to the crime, legal actions taken, or strong suspicion by the staff. The relationship of abusers to victims was analyzed. Results. Male victims accounted for 60.3% of the cases. Twenty-three percent of the children died, although death rates for boys and girls did not vary significantly. Male perpetrators outnumbered females 2.2:1, with fathers, step-fathers, and mothers' boyfriends committing over 60% of the crimes. Fathers accounted for 37% of the abusers, followed by boyfriends at 20.5%. Female baby-sitters, at 17.3%, were a large, previously unrecognized group of perpetrators. Mothers were responsible for only 12.6% of our cases. All but one of the confessed abusers were with the child at the time of onset of symptoms. Conclusions. Our data suggest male caretakers are at greater risk to abuse infants. Baby-sitters are a concerning risk group, because they represent a significant proportion of abusers, and they more easily escape prosecution. In addition, no prevention efforts have been directed at baby-sitters. These statistics could help change the focus of efforts to prevent abusive head trauma.

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Impact of alcohol and drug use on bicycle and electric scooter injuries and hospital admissions in the United States

Trauma ◽

10.1177/14604086211044353 ◽

2021 ◽

pp. 146040862110443

Author(s):

Nikan K Namiri ◽

Austin W Lee ◽

Gregory M Amend ◽

Jason Vargo ◽

Benjamin N Breyer

Keyword(s):

United States ◽

Drug Use ◽

Head Trauma ◽

Hospital Admissions ◽

Body Part ◽

The United States ◽

Severe Injuries ◽

Injury Surveillance System ◽

Alcohol And Drug Use ◽

Awareness Campaigns

Introduction Bicycles and electric scooters (e-scooters) are convenient and accessible means of transportation. Participant safety is contingent on available infrastructure and safe riding practices including not riding while intoxicated. Understanding national prevalence and injury characteristics of bicycle and e-scooter riders who ride while intoxicated may promote awareness campaigns for safe riding practices and decrease morbidity. Methods The National Electronic Injury Surveillance System (NEISS) provides national estimates of injuries that present to emergency departments across the United States. We obtained case information on admitting status, body part injured, diagnosis of injury, age, sex, alcohol usage, and drug usage. We then queried NEISS for injuries related to bicycles and e-scooters in 2019. Results A weighted total of 270,571 (95% confidence interval (CI): 204,517–336,625) bicycle injuries occurred in the United States during 2019; alcohol and drug use were associated with 7% (95% CI: 6–9) and 2% (95% CI: 2–3) of all injuries, respectively. Twenty-four percent (CI: 18--31) of alcohol- and 29% (95% CI: 20–41) of drug-related bicycle injuries resulted in hospital admissions, compared to 15% (95% CI: 12–17) of non–alcohol- and 15% (95% CI: 13–18) of non–drug-related injuries ( p < .001 and p = .002, respectively). A total of 28,702 (95% CI: 13,975–43,428) e-scooter injuries occurred in 2019; alcohol and drug use were associated with 8% (95% CI: 5–12) and 1% (95% CI: 1–2) of injuries, respectively. Sixty percent (95% CI: 47–72) of alcohol-related e-scooter injuries resulted in head trauma, compared to 28% (95% CI: 24–32) of non–alcohol-related injuries ( p < .001). Conclusions Intoxication is associated with increasingly severe injuries, hospital admissions, and head trauma in bicycle and e-scooter riders. The findings support awareness campaigns to educate riders about risky practices, improve non-auto infrastructure, and promote helmet usage.

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