SDH and EDH in children up to 18 years of age—a clinical collective in the view of forensic considerations

• Published in: International journal of legal medicine Vol. 132; no. 6; pp. 1719 - 1727
• Main Authors: Gekat, Wiebke, Binder, Svenja, Wetzel, Christian, Rothschild, Markus A., Banaschak, Sibylle
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2018; Springer Nature B.V
• Subjects: Accidents - statistics & numerical data; Adolescent; Age; Bleeding; Child; Child Abuse - diagnosis; Child Abuse - statistics & numerical data; Child, Preschool; Children; Correlation analysis; Extreme values; Female; Forensic engineering; Forensic Medicine; Germany - epidemiology; Hematoma, Epidural, Cranial - epidemiology; Hematoma, Subdural - epidemiology; Hemorrhage; Humans; Infant; Infant, Newborn; Injuries; Male; Medical Law; Medicine & Public Health; Original Article; Retinal Hemorrhage - epidemiology; Retrospective Studies; Skull Fractures - epidemiology; Abusive head trauma; Child abuse; Shaken baby syndrome; Epidural bleeding; Subdural bleeding
• ISSN: 0937-9827; 1437-1596
• DOI: 10.1007/s00414-018-1889-2

Providing concise proof of child abuse relies heavily on clinical findings, such as certain patterns of injury or otherwise not plausibly explainable trauma. Subdural hemorrhaging has been identified as a common occurrence in abused children whereas epidural hemorrhaging is related to accidents. In order to explore this correlation, we retrospectively analyzed clinical data of children under 19 years of age diagnosed with either injury. Reviewing 56 cases of epidural and 38 cases of subdural bleeding, it was shown that subdural bleeding is more common in young children and extremely often a result of suspected abuse in children under 2 years of age. Epidural hemorrhaging however never was found in the context of suspected abuse, was unrelated to other injuries typical for abuse, and did not see a statistically significant increase in any age group. In conformity with currently theorized mechanisms of injury for both types of bleeding, we found that subdural hemorrhaging in young children is closely associated with abuse whereas epidural bleeding is not.