Witnessing abusive head trauma: Accidents show higher rates of intracranial pathologies than shaking

Abstract Objectives This study aims to determine whether intracranial injuries, such as seizures, encephalopathy, bilateral subdural hematoma (SDH), and severe bilateral retinal hemorrhage (RH), are indicators of abusive head trauma (AHT), particularly in cases involving shaking. Methods Data comprising 54 witnessed shaking cases were drawn from two studies in the literature. Data of 100 witnessed accidents comes from the pediBIRN collaboration. Rates of intracranial injuries in cases of unconflicted witnessed accidents are compared to rates in cases of witnessed shaking and also to cases of unconflicted witnessed shaking. Unconflicted is defined as observed by an independent, unbiased witness, or by a potentially biased witness (such as partner) if reported prior to medical examinations. Results When all witnessed shaking cases were considered, including potentially biased witnesses, there are higher rates of findings commonly associated with AHT in witnessed accidents than in cases of witnessed shaking, although the difference is only statistically significant for seizures and encephalopathy. When restricted to cases when the witness was unconflicted, the rates of all findings are significantly more common in accidents than in shaking. Interpretation Accidents result in more severe intracranial pathologies than shaking, aligning with biomechanical studies that have shown that impact exerts greater force on the brain than violent shaking.