Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Miller is concerned that the method
we used to diagnose inflicted TBI was capricious. We decided a priori that
the people most likely to correctly judge whether a TBI was inflicted or noninflicted
were members of the team caring for the child, as they had primary information.
The research team did not directly question parents about the circumstances
of injury, as this inquiry would have added risks to the parents related to
research participation and likely would have resulted in greater loss of participants
and less generalizability. For children who died with TBI, we relied on reports
from the Office of the Chief Medical Examiner, which included the medical
team's evaluation (when available), the police investigation, and the autopsy
report. When an abusive injury was suspected, most attending physicians asked
for a consultation with a child abuse team. Generally, these teams consisted
of a child abuse expert, social workers, and others. All available information
was considered including the child's past medical history, the caregiver's
history of events, whether the description of the mechanism of injury fit
the documented injuries, and whether there were injuries other than the head
injury (eg, fingertip bruising on the thorax, rib fractures, skull fractures,
metaphyseal fractures, multiple fractures in different stages of healing,
retinal hemorrhages). In this way the team was able to come to a reasonable
conclusion about the likelihood of inflicted injury.
Keenan HT, Runyan DK. School-Based Interventions for Children Exposed to Violence—Reply. JAMA. 2003;290(19):2542-2543. doi:10.1001/jama.290.19.2542-a