Thresholds for the assessment of inflicted head injury by shaking trauma in infants

Thresholds for the assessment of inflicted head injury by shaking trauma in infants: a systematic review

Schiks, L.A.H. (TU Delft Medical Instruments & Bio-Inspired Technology)
Dankelman, J. (TU Delft Medical Instruments & Bio-Inspired Technology)
Loeve, A.J. (TU Delft Medical Instruments & Bio-Inspired Technology; Co van Ledden Hulsebosch Center for Forensic Science and Medicine)

2020

In order to investigate potential causal relations between the shaking of infants and injuries, biomechanical studies compare brain and skull dynamic behavior during shaking to injury thresholds. However, performing shaking tolerance research on infants, either in vivo or ex vivo, is extremely difficult, if not impossible. Therefore, infant injury thresholds are usually estimated by scaling or extrapolating adult or animal data obtained from crash tests or whiplash experiments. However, it is doubtful whether such data accurately matches the biomechanics of shaking in an infant. Hence some thresholds may be inappropriate to be used for the assessment of inflicted head injury by shaking trauma in infants. A systematic literature review was conducted to 1) provide an overview of existing thresholds for head- and neck injuries related to violent shaking, and 2) to identify and discuss which thresholds have been used or could be used for the assessment of inflicted head injury by shaking trauma in infants. Key findings: The majority of studies establishing or proposing injury thresholds were found to be based on loading cycle durations and loading cycle repetitions that did not resemble those occurring during shaking, or had experimental conditions that were insufficiently documented in order to evaluate the applicability of such thresholds. Injury thresholds that were applied in studies aimed at assessing whether an injury could occur under certain shaking conditions were all based on experiments that did not properly replicate the loading characteristics of shaking. Somewhat validated threshold scaling methods only exist for scaling concussive injury thresholds from adult primate to adult human. Scaling methods that have been used for scaling other injuries, or for scaling adult injury thresholds to infants were not validated. There is a clear and urgent need for new injury thresholds established by accurately replicating the loading characteristics of shaking.

child abuse
forensic science
head injury
injury tolerance
shaking trauma

http://resolver.tudelft.nl/uuid:e951abb1-4665-4747-9922-3c029039964e

https://doi.org/10.1016/j.forsciint.2019.110060

2020-05-18

0379-0738

Forensic Science International: an international journal dedicated to the applications of genetics in the administration of justice, 306

Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.

Institutional Repository

journal article

© 2020 L.A.H. Schiks, J. Dankelman, A.J. Loeve