定义和解释摇晃的婴儿综合症和虐待性头部创伤

通常,与SBS / AHT相关的术语不能正确互换使用。当混入困难的医学术语时,这些术语通常会在客户,律师,法官和陪审团之间引起相当大的混乱。在这篇文章中,我将解释SBS领域中使用的一些通用术语,并确定使用它们的原因,将其发展与SBS / AHT的历史联系起来,并简要地解决一些问题,这些问题将给那些被错误地指控为虐待。

"Shaking" refers to the physical act of moving a child to and fro. While it is never appropriate to shake a child, as physical harm may occur, when 发抖 is used in the child abuse realm, there is an implied assumption of violent 发抖. The mental image generated by the term "shaking"是一个小孩'头部快速连续地前后移动。更重要的是,这暗示着振动器的动机或意图是,所造成的任何伤害都是有意或可预见的。

摇摇婴儿综合症(SBS)。 这是指一种假设或信念"shaking"根据三种医疗状况的存在,可以可靠地将其诊断为观察到的伤害原因。的"triad"SBS的症状包括硬膜下出血(脑出血),视网膜出血(眼出血)和脑病(脑损伤)。如果在医院评估的儿童中发现了这三种伤害,但没有明确的解释(例如,交通事故,重大跌倒),则将给出SBS的默认诊断。人们认为,颅骨内部大脑的快速运动和突然停止会导致大脑内部桥接静脉,眼睛的视网膜静脉以及大脑神经或轴突的创伤性破裂。 SBS是这些伤害的原始工作名称或解释,但随后被替换为"abusive head trauma" (AHT) when biomechanical studies failed to support the idea that sufficient force could be generated from 发抖 alone to cause the 三合会.

震动影响综合症(SIS)。 This term was advanced as a result of biomechanical criticisms of SBS. The idea was that the 三合会, subdural hemorrhage, retinal hemorrhage and encephalopathy are caused not just by violent 发抖 alone, but by 发抖 followed by impact, such as tossing or slamming a child. The thought was that 发抖 followed by an abrupt stop would produce much greater force than that produced by 发抖 alone. Somehow, which makes little sense to me, under this theory the forces applied to the brain and eyes by the sudden acceleration or deceleration created by tossing followed by abrupt landing is somehow greater than that caused by the rapid change in the direction of the head by 发抖 alone.

虐待性头部创伤(AHT)。 The increase in criticism against SBS and SIS led to the development of this term. In 2009, the American Academy of Pediatrics recommended that this term be used instead of SBS. AHT refers to any deliberately inflicted injury to the head, regardless of mechanism. Hence, 发抖 is only one form of possible AHT. AHT includes hitting, throwing onto a hard or soft surface, crushing, or any other possible form of traumatic injury. The prevalence of this term is directly related to the fact that it eliminates the necessity of the medical field to provide a definitive mechanism of injury. Rather, AHT becomes a self-fulfilling prophecy. The 三合会 is observed, no other acceptable explanation is provided, therefore, we know that AHT is the cause, and we need not explain exactly what was done to the child. Rather, we know there was some kind of AHT as the 三合会 is observed, and we only see the 三合会 if there is AHT.

非意外伤害(NAI)。 This term is also commonly used as a substitute for AHT, and it is used in cases in which the 三合会 is absent. It is frequently used in "fracture cases." These are cases in which the alleged abuse is seen only in the area of fractured or broken bones. It refers to any injury caused by a means other than accident. It too, works as a self-fulfilling prophecy as no specifics for the observed bone fractures must be given. Further, 发抖 and violent 发抖 are often one of the endless possible mechanisms of injury, but no specific explanation must be given. Rather, the absence of a stated viable explanation (car accident, fall from monkey bars) results in the default diagnosis of abuse, called NAI.

钝力创伤(BFT)。 对头部的钝力创伤是指对头部的任何不穿透头皮的冲击。它包括偶然的和非偶然的(滥用)。法医病理学家或医学检查人员最常使用此术语。但是,该术语没有推断的意图。


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