Physicians' initial forensic impressions of hypothetical cases of pediatric traumatic brain injury

Objective: To describe physicians' initial forensic impressions of hypothetical cases of pediatric traumatic brain injury (TBI) and to compare the responses of pathologists and pediatricians. Method: A survey was administered to physicians who attended workshops on pediatric TBI; were members of two national internet list serves; and were members of the Section on Child Abuse and Neglect of the American Academy of Pediatrics (N = 522) and the National Association of Medical Examiners (N = 815). The survey included 16 hypothetical case scenarios depicting a pediatric TBI. Participants were asked to categorize their initial forensic impressions of each scenario on a seven-point scale from definitive unintentional to definitive inflicted injury. Results: A total of 570 surveys were completed, including 465 of 1337 surveys (35%) distributed through the regular mail. In 8 of 16 hypothetical cases, a majority of respondents (range, 60-98%) and a majority of the more experienced respondents (range, 59-97%) categorized the hypothetical TBI as either unintentional or inflicted. Pathologists were less likely than the pediatric participants to view these scenarios as inflicted TBI. Conclusion: Certain features of TBI cases result in a majority of clinicians categorizing them as inflicted or intentional. In the absence of a confession of inflicted injury, witnessed or verifiable events, severe injuries without explanation or injuries that can be linked clearly to a perinatal period, clinicians were unable to agree on the etiology of the injury. Our results will be helpful to other researchers so that consistent, validated research definitions are used to classify pediatric TBI for research purposes.