TY  - JOUR
T1  - ANalysis of perpetrator admissions to inflicted traumatic brain injury in children
AU  - Starling SP, Patel S, Burke BL, Sirotnak AP, Stronks S, Rosquist P
Y1  - 2004/05/01
N1  - 10.1001/archpedi.158.5.454
JO  - Archives of Pediatrics & Adolescent Medicine
SP  - 454
EP  - 458
VL  - 158
IS  - 5
N2  - Background 
    Scientific and courtroom debate exists regarding the timing of onset of symptoms and the mechanism of injury in infants and children with inflicted traumatic brain injury (ITBI).Objectives 
    To determine the time interval between ITBI and the onset of symptoms and to explore the mechanism of ITBI.Design, Setting, and Patients 
    Retrospective review of all cases of pediatric ITBI admitted between January 1, 1981, and July 31, 2001, to a large academic medical center and cases admitted to 2 additional academic institutions between January 1, 1996, and August 31, 2000, and January 1, 2001, and July 31, 2001, comparing 81 cases of ITBI in which perpetrators admitted to abuse with 90 cases in which no abuse admission was made. The patients with perpetrator admissions to ITBI consisted of 53 boys (65%) and 28 girls (35%). Their ages ranged from 2 weeks to 52 months.Main Outcome Measures 
    Characteristics associated with perpetrator admissions to ITBI in children.Results 
    Shaking was the most common mechanism of injury among all cases with perpetrator admissions: 55 (68%) of the 81 perpetrators admitted to shaking the children. Impact was not described in 44 (54%) of the 81 cases. In cases in which only impact was described, 60% (12/20) of the children showed skull or scalp injury, compared with 12% (4/32) with skull or scalp injury in the shake only group. In 52 (91%) of 57 cases in which the time to the onset of symptoms was described, symptoms appeared immediately after the abuse. In 5 cases (9%), the timing of symptoms was less clear, but they occurred within 24 hours. None of the children were described as behaving normally after the event.Conclusions 
    The symptoms of inflicted head injury in children are immediate. Most perpetrators admitted to shaking without impact. These data, combined with the relative lack of skull and scalp injury, suggest that shaking alone can produce the symptoms seen in children with ITBI.
SN  - 1072-4710
M3  - doi: 10.1001/archpedi.158.5.454
UR  - http://dx.doi.org/10.1001/archpedi.158.5.454
ER  -