Lantz Patrick E, Couture Daniel E
Department of Pathology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1072, USA.
J Forensic Sci. 2011 Nov;56(6):1648-53. doi: 10.1111/j.1556-4029.2011.01892.x. Epub 2011 Aug 9.
We describe an infant with an acute subdural hematoma, a fatal head injury, and severe hemorrhagic retinopathy caused by a stairway fall. His cerebral and ocular findings are considered diagnostic of abusive head trauma by many authors. Our literature search of serious injuries or fatalities from stairway or low-height falls involving young children yielded 19 articles of primary data. These articles are discrepant, making the classification of a young child's death following a reported short fall problematic. This case report contradicts the prevalent belief of many physicians dealing with suspected child abuse that low-height falls by young children are without exception benign occurrences and cannot cause fatal intracranial injuries and severe retinal hemorrhages. The irreparable harm to a caregiver facing an erroneous allegation of child abuse requires physicians to thoroughly investigate and correctly classify pediatric accidental head injuries.
我们描述了一名因楼梯摔倒导致急性硬膜下血肿、致命性头部损伤和严重出血性视网膜病变的婴儿。许多作者认为他的脑部和眼部检查结果可诊断为虐待性头部创伤。我们对涉及幼儿的楼梯或低高度摔倒导致的重伤或死亡进行文献检索，得到了19篇原始数据文章。这些文章存在分歧，使得报告的短距离摔倒后幼儿死亡的分类存在问题。本病例报告与许多处理疑似虐待儿童问题的医生的普遍看法相矛盾，即幼儿低高度摔倒无一例外都是良性事件，不会导致致命的颅内损伤和严重的视网膜出血。面对虐待儿童错误指控对照顾者造成的无法弥补的伤害，要求医生对儿科意外头部损伤进行彻底调查并正确分类。
