Atwal G S, Rutty G N, Carter N, Green M A
Manchester Medical School, Manchester University, UK.
Forensic Sci Int. 1998 Sep 28;96(2-3):215-30. doi: 10.1016/s0379-0738(98)00126-1.
Non-accidental head injury, be it shaking, impact(s) or a combination of the two, is characterised by subdural and/or subarachnoid haemorrhages with retinal haemorrhages, but minimal or absent external cranio-facial trauma. The classical assault scenario depicts the infant being gripped around the head, face, chest and abdomen and shaken or being gripped by a limb and swung. This gripping might be expected to leave physical evidence in the form of bruising. A study was undertaken to establish the prevalence, distribution and pathological association of external bruising in 24 cases of fatal non-accidental head injury in children. At autopsy, 17 cases had new external bruises, 15 old external bruises and 13, a combination of both. However, seven (29%) cases showed no fresh external bruising and five (21%) showed no external bruising at all. Thus, external bruising may be absent in children with fatal intracranial injury. The face was shown to be the commonest site of bruising followed by the forehead and buttocks. Limb, chest and abdominal bruising were found to be uncommon. Retinal haemorrhages were confirmed in 23 (96%) cases. It is hypothesised that bruising, when present, may be a result of abuse in the form of punches and slaps rather than due to gripping during the assault. We discuss why gripping does not necessarily result in external bruising.
非意外性头部损伤，无论是摇晃、撞击或两者结合，其特征为硬膜下和/或蛛网膜下腔出血伴视网膜出血，但颅面部外部创伤轻微或无创伤。典型的攻击场景描述为婴儿的头部、面部、胸部和腹部被抓住并摇晃，或者肢体被抓住并甩动。这种抓握可能会留下瘀伤形式的身体证据。一项研究旨在确定24例儿童致命非意外性头部损伤中外部瘀伤的发生率、分布及病理关联。尸检时，17例有新的外部瘀伤，15例有陈旧性外部瘀伤，13例两者皆有。然而，7例（29%）无新鲜外部瘀伤，5例（21%）完全没有外部瘀伤。因此，致命性颅内损伤儿童可能没有外部瘀伤。结果显示，面部是最常见的瘀伤部位，其次是前额和臀部。发现肢体、胸部和腹部瘀伤并不常见。23例（96%）确诊有视网膜出血。据推测，若存在瘀伤，可能是拳打脚踢和扇耳光形式的虐待所致，而非攻击过程中的抓握造成。我们讨论了为什么抓握不一定会导致外部瘀伤。
