The diagnosis of non-accidental head injury (NAHI) is based on specific traumatic injuries listed in national recommendations published by the Haute Autorité de Santé (HAS, French national authority for health). Forensic experts play a central role in these cases. However, they often have limited knowledge of judicial outcomes, providing the rationale for this study.

This retrospective single-center study covers 11 years of NAHI cases diagnosed and evaluated by the forensic medicine department of Angers University Hospital. Medical data were obtained from departmental archives, while judicial data were provided by a trainee judge with the authorization of the prosecutor. For each case, a score was assigned for the likelihood of a NAHI diagnosis and a score for the severity of the corresponding judicial outcome.

Of the 65 cases included, only 28 were referred to the competent court. Of these, 22 resulted in custodial sentences, most of which were suspended, with a mean duration of 29 months, and 5 resulted in acquittals. No statistically significant correlation was observed between the likelihood of a NAHI diagnosis and the severity of the judicial decision. Only 13 sets of reasons for judgment were made available; nevertheless, they provided valuable insight.

The severity of judicial outcomes was not associated with the diagnostic probability of NAHI according to the HAS criteria, suggesting that legal decisions rely on a combination of forensic evidence and broader judicial factors, particularly the identification of the perpetrator. The findings highlight the importance of accurate forensic assessment, especially injury chronology and, when possible, the estimation of the number of shaking episodes, as these elements may be decisive when multiple caregivers are involved.