Histological dating of subdural hematoma in infants.
Bilirubin
/ metabolism
Child, Preschool
Collagen
/ metabolism
Dura Mater
/ metabolism
Erythrocytes
/ metabolism
Female
Fibrin
/ metabolism
Fibroblasts
/ metabolism
Forensic Pathology
/ methods
Hematoma, Subdural
/ pathology
Humans
Infant
Infant, Newborn
Intracranial Thrombosis
/ metabolism
Lymphocytes
/ metabolism
Macrophages
/ metabolism
Male
Neovascularization, Pathologic
Postmortem Changes
Reticulin
/ metabolism
Retrospective Studies
Age estimation
Dating
Histology
Posttraumatic interval
Shaken baby syndrome
Subdural hematoma
Journal
International journal of legal medicine
ISSN: 1437-1596
Titre abrégé: Int J Legal Med
Pays: Germany
ID NLM: 9101456
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
21
09
2018
accepted:
05
12
2018
pubmed:
17
12
2018
medline:
4
4
2019
entrez:
17
12
2018
Statut:
ppublish
Résumé
After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (SDH), the magistrates ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of NAHI. We aimed to develop an SDH dating system applicable to infants aged under 3 years. We studied a retrospective multicenter collection of 235 infants who died between the ages of 0 and 36 months, diagnosed with SDH by forensic pathological examination and with known posttraumatic interval (PTI). Two pathologists assessed blindly and independently 12 histomorphological criteria relating to the clot and 14 relating to the dura mater in 73 victims (31 girls, 42 boys) whose median age was 3.8 months. Histopathological changes were significantly correlated with PTI for the appearance of red blood cells (RBCs) and the presence or absence of siderophages, and regarding the dura mater, the quantity of lymphocytes, macrophages, and siderophages; presence or absence of hematoidin deposits; collagen and fibroblast formation; neomembrane thickness; and presence or absence of neovascularization. Dating systems for SDH in adults are not applicable to infants. Notably, neomembrane of organized connective tissue is formed earlier in infants than in adults. Our dating system improves the precision and reliability of forensic pathological expert examination of NAHI, particularly for age estimation of SDH in infants. However, the expert can only define a time interval. Histopathology is indispensable to detect repetitive trauma.
Sections du résumé
BACKGROUND
BACKGROUND
After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (SDH), the magistrates ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of NAHI. We aimed to develop an SDH dating system applicable to infants aged under 3 years.
METHODS AND RESULTS
RESULTS
We studied a retrospective multicenter collection of 235 infants who died between the ages of 0 and 36 months, diagnosed with SDH by forensic pathological examination and with known posttraumatic interval (PTI). Two pathologists assessed blindly and independently 12 histomorphological criteria relating to the clot and 14 relating to the dura mater in 73 victims (31 girls, 42 boys) whose median age was 3.8 months. Histopathological changes were significantly correlated with PTI for the appearance of red blood cells (RBCs) and the presence or absence of siderophages, and regarding the dura mater, the quantity of lymphocytes, macrophages, and siderophages; presence or absence of hematoidin deposits; collagen and fibroblast formation; neomembrane thickness; and presence or absence of neovascularization. Dating systems for SDH in adults are not applicable to infants. Notably, neomembrane of organized connective tissue is formed earlier in infants than in adults.
CONCLUSION
CONCLUSIONS
Our dating system improves the precision and reliability of forensic pathological expert examination of NAHI, particularly for age estimation of SDH in infants. However, the expert can only define a time interval. Histopathology is indispensable to detect repetitive trauma.
Identifiants
pubmed: 30554266
doi: 10.1007/s00414-018-1980-8
pii: 10.1007/s00414-018-1980-8
doi:
Substances chimiques
Reticulin
0
Fibrin
9001-31-4
Collagen
9007-34-5
Bilirubin
RFM9X3LJ49
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
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