Judicial handling of cases of non-accidental head trauma in infants: Review and analysis of expert assessments - 06/05/21

Doi : 10.1016/j.neuchi.2021.04.014

C. Delteil ^a,^b,^⁎ , L. Tuchtan ^a,^b, D. Scavarda ^c, M.-D. Piercecchi-Marti ^a,^b, E. Bosdure ^d, C. Borrione ^e
^a Forensic Department, AP–HM, La Timone, 264, rue St-Pierre, 13385 Marseille cedex 05, France
^b Aix-Marseille University, CNRS, EFS, ADES, Marseille, France
^c Department of Paediatric Neurosurgery, CHU Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
^d Paediatric Department, CHU Timone Enfants, 264 rue Saint Pierre, 13385 Marseille cedex 05, France
^e Department of Paediatric Surgery, CHU Timone Enfants, 264 rue Saint Pierre, 13385 Marseille cedex 05, France

^⁎Corresponding author. Forensic Department, AP–HM, La Timone, 264, rue St-Pierre, 13385 Marseille cedex 05, France.Forensic Department, AP–HM, La Timone264, rue St-PierreMarseille cedex 0513385France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 06 May 2021
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Highlights

•	Professional guidelines are an undeniable aid in determining the causal mechanism of the lesions and certainty of a suspected NAHI.
•	These recommendations must be well properly adhered to by medical teams.
•	Their disrespect limits the extent to which perpetrator(s) of violence are recognised.
•	There is a low number of convictions resulting from judicial investigations.

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Abstract

Introduction

Good practice guidelines help clinicians to establish a suspected diagnosis of non-accidental head injury (NAHI) and help forensic experts to establish a level of certainty for the diagnosis.

The objective of this study was to assess how the French Health Authority (HAS) guidelines contribute to the process of producing an expert assessment, on causation and certainty in cases of suspected NAHI.

Method

A retrospective study was conducted of the expert assessments that were conducted by a paediatric surgeon and forensic expert attached to our local court between 2002 and 2018, with the aim of determining the causal mechanism of the lesions and express a degree of certainty regarding the diagnosis.

Results

In our study, we found that, despite the HAS guidelines, a number of documents deemed essential for the forensic expert were sometimes missing, and that, by applying these guidelines, the decisions reached in some expert assessments could been reclassified and certain factors formerly described as risk factors for injury could be excluded. A precise dating of the traumatic event was proposed in half of cases.

Conclusion

Our study highlights the vital role of the HAS guidelines, not only for patient management but also to ensure high-quality expert assessments. Unfortunately, guidelines were not yet being properly adhered to by medical teams.

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Keywords : Non-accidental head injury, Expert assessment, Good practice guidelines, Child abuse, Shaken baby syndrome