Table 1.
A priori definitional criteria for AHT, non-AHT, an abnormal skeletal survey, and an abnormal retinal exam.
| A patient’s head trauma was classified as abusive IF… |
| • The primary caregivera admitted abusive acts, OR… |
| • Abusive acts by the primary caregivera were witnessed by an unbiased, independent observer, OR… |
| • The primary caregivera specifically denied that the pre-ambulatory infant or young child in his/her care had experienced any head trauma, OR… |
| • The primary caregivera provided an account of the child’s head injury event that was clearly historically inconsistent with repetition over time, OR… |
| • The primary caregivera provided an account of the child’s head injury event that was clearly developmentally inconsistent with the child’s known (or expected) gross motor skills, OR… |
| • Abuse evaluation revealed patterned bruising or dry contact burns, hot water immersion burns, or CT-confirmed intra-abdominal injury. |
| A patient’s head trauma was classified as non-abusive IF… |
| • The child’s head injury event was witnessed by an unbiased, independent observer who described the event as accidental (non-abusive), OR… |
| • The primary caregivera provided an account of the child’s head injury event that was both historically consistent with repetition over time and developmentally consistent with the child’s known (or expected) gross motor skills…AND…abuse evaluation failed to reveal patterned bruising or dry contact burns, hot water immersion burns, or CT-confirmed intra-abdominal injury |
| A patient’s skeletal survey was classified as abnormal IF… |
| • The survey revealed rib fracture(s), classic metaphyseal lesion fracture(s), epiphyseal separation(s), fracture(s) of the scapula or sternum, fracture(s) of digit(s), vertebral body fracture(s) or dislocation(s) OR fracture(s) of spinous process(es) |
| A patient’s retinal examination was classified as abnormal IF… |
| • The exam by an ophthalmologist revealed retinoschisis OR retinal hemorrhages described as dense, extensive, covering a large surface area, and/or extending to the ora serrata |
Abbreviations: AHT=abusive head trauma
a
The primary caregiver was defined a priori as the person responsible for the child when he/she was acutely head-injured or first became clearly and persistently ill with clinical signs linked to acute traumatic head injuries confirmed on neuroimaging.