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November 19, 2003

Incidence of Inflicted Traumatic Brain Injury in Infants

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(19):2542-2543. doi:10.1001/jama.290.19.2542-a

To the Editor: Dr Keenan and colleagues1 collected data from 9 hospitals in North Carolina to derive population-based estimates and demographics of inflicted traumatic brain injury (TBI) in children aged 2 years or younger in the United States. I am concerned that the criteria used to make the diagnosis of inflicted TBI were vague and subjective. In the study by Keenan et al, inflicted TBI was diagnosed either if there was a confession or if review by a medical and child protective team deemed that the case was child abuse. However, the authors did not describe how many of their 80 cases of inflicted TBI were based on which of these 2 criteria. Furthermore, they did not describe the background or expertise of the protective teams, what criteria they used to determine whether an inflicted TBI had occurred, or how their decisions were made when the parents/caregivers denied wrongdoing. It is possible that the teams may have mistakenly diagnosed inflicted TBI when in fact the cause was accidental.

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