Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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.
Miller M. Incidence of Inflicted Traumatic Brain Injury in Infants. JAMA. 2003;290(19):2542-2543. doi:10.1001/jama.290.19.2542-a