Sir.—Despite increased awareness of the presence of child abuse, nearly 1100 children still succumb to fatal shaking or blunt traumatic injuries inflicted by adults each year in the United States.2 Nearly 150000 children suffer serious injuries and many are permanently disabled.2 Therefore, it is extremely important that clinicians recognize any sign, symptom, or laboratory result in a child that may be a manifestation of child abuse if further abuse and perhaps death are to be prevented.
A previous report3 described three patients in whom the diagnosis of child abuse was delayed because of misinterpretation of bloody cerebrospinal fluid (CSF). We report herein two fatal cases involving children who underwent diagnostic lumbar puncture that yielded bloody CSF that
SPEAR RM, CHADWICK D, PETERSON BM. Fatalities Associated With Misinterpretation of Bloody Cerebrospinal Fluid in the 'Shaken Baby Syndrome'. Am J Dis Child. 1992;146(12):1415–1417. doi:10.1001/archpedi.1992.02160240025007