Abstract
Violent shaking is believed to be a common mechanism of injury in pediatric abusive head trauma. Typical intracranial injuries include subdural and retinal hemorrhages. Using a laboratory surrogate model we conducted experiments evaluating the head motion patterns that may occur in violent shaking. An anthropomorphic test device (ATD; Q0 dummy) matching an infant of 3.5 kg was assembled. The head interior was equipped with accelerometers enabling assessment of three-axial accelerations. Fifteen volunteers were asked to shake the surrogate vigorously holding a firm grip around the torso. We observed the volunteers performing manual shaking of the surrogate at a median duration of 15.5 sec (range 5–54 sec). Typical acceleration/deceleration patterns were produced after 2–3 shakes with a steady-state shaking motion at a pace of 4–6 cycles (back and forth) per second. Mean peak sagittal tangential accelerations at the vertex were 45.7g (range 14.2–105.1g). The acceleration component in the orthogonal direction, the radial acceleration, fluctuated around a negative mean of more than 4g showing that the surrogate head was continuously subjected to centripetal forces caused by rotations.This surrogate experiment showed that violent shaking may induce high peak tangential accelerations and concomitantly a continuous high-magnitude centripetal force. We hypothesize that the latter component may cause increased pressure in the subdural compartment in the cranial roof and may cause constant compression of the brain and possibly increased stretching or shearing of the bridging veins. This may contribute to the mechanism accountable for subdural hematoma in abusive head trauma.
Highlights
IntroductionThe injury mechanisms are controversial and include various forms of violence such as blunt force impact, shaking, and compression.[1] Victims of Abusive head trauma (AHT) may present with subdural hemorrhages, retinal hemorrhages, and various degrees of encephalopathy, often with absent or inconsistent history, and commonly accompanied by other injuries indicative of abuse, such as fractures and bruises.[3,4] Signs of direct impact to the head are lacking in a large proportion of the victims
Abusive head trauma (AHT) is a major cause of morbidity and mortality in infants and young children.[1,2,3,4]The injury mechanisms are controversial and include various forms of violence such as blunt force impact, shaking, and compression.[1]
Victims of AHT may present with subdural hemorrhages, retinal hemorrhages, and various degrees of encephalopathy, often with absent or inconsistent history, and commonly accompanied by other injuries indicative of abuse, such as fractures and bruises.[3,4]
Summary
The injury mechanisms are controversial and include various forms of violence such as blunt force impact, shaking, and compression.[1] Victims of AHT may present with subdural hemorrhages, retinal hemorrhages, and various degrees of encephalopathy, often with absent or inconsistent history, and commonly accompanied by other injuries indicative of abuse, such as fractures and bruises.[3,4] Signs of direct impact to the head are lacking in a large proportion of the victims
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