AHT Definitional Criteria

Patients were sorted as abused if and when any of the following were true.

• Primary caregiver admission of abusive acts
• Primary caregiver denial of any head trauma, even though the pre-ambulatory child in his or her care became acutely, clearly and persistently ill with clinical signs subsequently linked to traumatic cranial injuries visible on CT or MR imaging
• Primary caregiver account of the child’s head injury event that was clearly historically inconsistent with repetition over time
• Primary caregiver account of the child’s head injury event that was clearly developmentally inconsistent with child’s known (or expected) gross motor skills
• Two or more categories of extra-cranial injuries considered moderately or highly suspicious for abuse, including:
  • Classic metaphyseal lesion fracture(s) or epiphyseal separation(s)
  • Rib fracture(s)
  • Fracture(s) of the scapula or sternum; fracture(s) of digits
  • Vertebral body fracture(s), dislocation(s) or fracture(s) of spinous process(es)
  • Skin bruising, abrasion(s) or laceration(s) in two or more distinct locations other than knees, shins or elbows
  • Patterned skin bruising or dry contact burn(s)
  • Scalding burn(s) with uniform depth, clear lines of demarcation and paucity of splash marks
  • Confirmed intra-abdominal injuries
  • Retinoschisis confirmed by an ophthalmologist
  • Retinal hemorrhages described by an ophthalmologist as dense, extensive, covering a large surface area and/or extending to the ora serrata.