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November 19, 2003

School-Based Interventions for Children Exposed to Violence—Reply

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

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.