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Forum Home > Skull Fxs > Barnes' 2011 "Imaging of NAI and the Mimics..."

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Dr. Barnes has put together an amazing journal article this year discussing the issues surrounding Non-Accidental Injury and its relevance in Evidence-Based Medicine. The article thoroughly examines the spectrum of injuries associated with NAI (e.g. Shaken Baby Syndrome), such as subdural hematoma, retinal hemorrhages, fractures, brain swelling, etc.

He says this on other literature on child abuse that has been written:

"Evidence-based medicine (EBM) is now the guiding principle as medicine moves from an authoritarian to an authoritative era to overcome bias and ideology...Difficulties exist in the rational formulation of a medical diagnosis or forensic determination of NAI/SBS based on an alleged event (eg, shaking) that is inferred from clinical, imaging, or pathology findings in the subjective context of

" (1) an unwitnessed event,

"(2) a noncredible history,


"(3) an admission or confession under dubious circumstances.

"This problem is further confounded by the lack of consistent and reliable criteria for the diagnosis of NAI/SBS and because much of the traditional literature on child abuse consists of anecdotal case series, case reports, reviews, opinions, and position papers.  Many reports include cases having impact injury, which undermines the SBS hypothesis by imposing a shaking-impact syndrome.

"Also, the inclusion criteria provided in many reports are criticized as arbitrary.  Examples include suspected abuse, presumed abuse, likely abuse, and indeterminate.

"Furthermore, the diagnostic criteria often seem to follow circular logic, such that the inclusion criteria (eg, the triad equals SBS/NAI) becomes the conclusion (ie, SBS/NAI equals the triad)."

[emphasis added by me]

It is important while reading medical journals to ensure that scientific reasoning was used. Otherwise the study is flawed; the conclusion becomes faulty. However, the data never lies. Sometimes the truth may be discovered by examining the data, regardless of the conclusions drawn by the authors.

Lately prosecutors have started claiming that anything over 4-5 years old in medical literature is obsolete.

This is just published in 2011. It's copyrighted, and available at cost at:

Radiol Clin N Am 49 (2011) 205–229 doi:10.1016/j.rcl.2010.08.001 0033-8389/11/$

November 23, 2011 at 12:40 PM Flag Quote & Reply

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