Gekat Wiebke, Binder Svenja, Wetzel Christian, Rothschild Markus A, Banaschak Sibylle
Institute of Legal Medicine, University Hospital of Cologne, Melatenguertel 60/62, 50823, Cologne, Germany.
Clinic and Polyclinic of Neurosurgery, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Int J Legal Med. 2018 Nov;132(6):1719-1727. doi: 10.1007/s00414-018-1889-2. Epub 2018 Jul 7.
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.
提供虐待儿童的确切证据在很大程度上依赖于临床发现，比如某些损伤模式或其他难以合理解释的创伤。硬膜下出血已被确认为受虐儿童的常见现象，而硬膜外出血则与意外事故有关。为了探究这种关联，我们回顾性分析了19岁以下诊断为这两种损伤之一的儿童的临床数据。在回顾的56例硬膜外出血和38例硬膜下出血病例中，结果显示硬膜下出血在幼儿中更为常见，并且在2岁以下儿童中极常是疑似虐待的结果。然而，硬膜外出血从未在疑似虐待的情况下被发现，与其他典型的虐待损伤无关，并且在任何年龄组中都没有出现统计学上的显著增加。与目前关于这两种出血类型的损伤机制理论一致，我们发现幼儿硬膜下出血与虐待密切相关，而硬膜外出血则不然。
