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<< Nonaccidental Injury in Pediatric Patients: Detection, Evaluation, and Treatment (Trauma CME)

Controversies and Cutting Edge

The field of child abuse is distinct from most other medical fields because there is a group (defense attorneys and witnesses) with a vested interest in creating controversy. This means that there are 2 layers of differentials: real (osteogenesis imperfecta, rickets, accidental trauma) and invented (infantile rickets, temporary brittle bone disease, hypoxia). Some of these invented controversies and how they have been debunked are discussed in the following sections.

Subdural Hematoma and Retinal Hemorrhage in Relation to Hypoxic-Ischemic Events

Geddes et al published a series of articles that compared the pathology of infants who died from AHT with those who died from hypoxic-ischemic causes.229-231 They proposed that infants with the combination of severe hypoxia, brain swelling, and raised central venous pressure develop blood leaks from intracranial veins into subdural spaces and report that a similar mechanism could account for retinal hemorrhage. 

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