Workshop 21

Mar 04, 2017 by AAPOS editor in  Workshop

Abusive Head Trauma: Primer and Mock Trial

Gil Binenbaum; Alex V. Levin; Steve E. Rubin; Brian J. Forbes

The Children’s Hospital of Philadelphia
Philadelphia, PA


Purpose/Relevance:  Severe retinal hemorrhage (RH), folds, and retinoschisis are highly suggestive of abusive head trauma (AHT) in young children. Ophthalmologists may testify about the significance of these findings, yet be faced with alternative hypotheses proposed by defense teams in court. Ophthalmologists should be familiar with strengths and limitations of their own expertise, relevant literature, and the process and challenges of giving court testimony.

Target Audience:  Ophthalmologists who evaluate children for possible abuse and may be called to appear in court as witnesses.

Current Practice:  Physicians may face aggressive challenges by attorneys, who have manufactured a false controversy over the diagnosis of AHT in the media and courtroom and offer outlier theories as causes of ocular findings. As cases move into the judicial system, ophthalmologists may be confused, frustrated and uncomfortable.

Best Practice:  Ophthalmologists play an important role in protecting both children and caregivers by providing professional unbiased evidence-based court testimony.

Expected Outcomes:  Participants will gain comfort in interpreting the diagnostic significance of RH patterns and testifying within the judicial system.

Format:  Short didactics combined with a mock trial, where workshop presenters will act as prosecution and defense attorneys, expert witnesses, and judge. The audience will be jury and vote before and after the initial case presentation, and with variations of the case, which may affect the audience’s verdict in interesting ways. commentary and advice on testifying in court, as well as time for discussion, will be provided.

Summary:  In court cases involving AHT, pediatric ophthalmologists may encounter questionable proposed alternative diagnoses, unsupported by peer-reviewed literature, and a manufactured controversy over the diagnosis of AHT. With both mini-lectures and a mock trial, we will emphasize key points for clinical practice and recreate the confrontational tone of the courtroom to better prepare the audience for testifying objectively and effectively.

References:  1. Levin A.V. Retinal hemorrhage in abusive head trauma. Pediatrics 2010;126(5):961-70.
2. Binenbaum G, Forbes BJ. The Eye in Child Abuse: Key Points on Retinal Hemorrhages and Abusive Head Trauma. Pediatric Radiology 2014. 44(Suppl 4): S571-7.

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