Age-diagnostics of subdural indicators of the shaken baby syndrome

• Applicant: Professor Dr. Daniel Wittschieber
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine
• Term: from 2018 to 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 410118577

By means of a comprehensive, novel, and retrospective study cohort, the envisaged research project aims at verifying the new knowledge on subdural hygromas (SDHy) and bridging vein thromboses (BVT), that has recently been gained in our study group. According to these data, SDHy and BVT may be criteria for age diagnostics of subdural collections (SDC). Furthermore, the project focuses on the investigation of sparsely considered parameters as to their suitability for age diagnostics. The scientific program of the envisaged research project comprises the following concrete objectives:(1.) Verification of the hypothesis that BVT are early phenomena in the evolution of SDC. This first requires the identification of BVT cases. Subsequently, age estimation of the BVT should be done by means of established approaches (well-known SDH stages, verification by serial neuroimaging, verification by confessions of perpetrators). (2.) Development of a novel, practically oriented category or stage system reflecting the age of SDC and considering different subdural parameters such as neomembranes, BVT, growth behavior and differences in density. For the assessment of these parameters, it is intended to study their evolution over time; thereby, uncovering forensically relevant changes.(3.) Verification of the hypothesis that minimal differences in density (measured in Hounsfield units) provide a possibility to distinguish SDHy from chronic SDH (cSDH). To this end, a sub-population of the study cohort must be established that is characterized by cerebrospinal fluid-like SDCs. In case of suitability for age diagnostics, this criterion should be included in objective no. 2.(4.) Verification of the hypothesis that SDHy classification systems originally developed in adults may also be available in infants and young children. To this end, a sub-population of the study cohort must be established that is characterized by SDHys only. In case of suitability for age diagnostics, this criterion should be included in objective no. 2. This comprises first the application of the mentioned classification systems on infants. Second, the suitability and practicability should be evaluated.(5.) By collecting non-radiologic and meta data, it is intended to outline the actual state of case work of shaken baby syndrome cases in Germany. On the one hand, this allows for the support of objective no. 2 by means of parameters that are independent of neuroimaging. On the other hand, the suitability and relevance of the clinico-radiological classification system proposed by Minns and Busuttil can be verified and correlated with so far unconsidered parameters (neomembranes, BVT, growth behavior), respectively.

• DFG Programme: Research Grants