The potential and limitations of utilising head impact injury models to assess the likelihood of significant head injury in infants after a fall.

The use of engineering principles in assessing head injury scenarios is of increasing significance in investigations into suspected child abuse. A fall scenario is often given as the history for a head injury to an infant. This paper addresses the basic engineering principles and factors to be considered when calculating the severity of a head impact after free-fall. The application of head injury models (HIMs) to ascertain the forces involved in childhood head injuries from impact is also discussed. Previous studies including Duhaime et al. [J. Neurosurg. 66 (1987) 409] and Nokes et al. [Forensic Sci. Int. 79 (1995) 85] have utilised HIMs for this purpose: this paper reviews those models most widely documented.The HIM currently considered the 'state-of-the-art' is the head injury criterion (HIC) and it is suggested that this model should be utilised for assessing head impact injury in child abuse cases where appropriate.

[1]  V. R. Hodgson,et al.  Effect of Long-Duration Impact on Head , 1972 .

[2]  James A. Newman,et al.  Biomechanics of Head Trauma: Head Protection , 2002 .

[3]  H. Masuzawa,et al.  Infantile acute subdural hematoma. Clinical analysis of 26 cases. , 1984, Journal of neurosurgery.

[4]  Harold J. Mertz,et al.  The Position of the United States Delegation to the ISO Working Group 6 on the Use of HIC in the Automotive Environment , 1985 .

[5]  E. H. Harris,et al.  Scaling of Experimental Data on Cerebral Concussion in Sub-Human Primates to Concussion Threshold for Man , 1967 .

[6]  T. B. Sweeney X-rated playgrounds? , 1979, Pediatrics.

[7]  Richard G. Snyder Study of impact tolerance through free-fall investigations. Final report , 1977 .

[8]  W Goldsmith,et al.  Current controversies in the stipulation of head injury criteria. , 1981, Journal of biomechanics.

[9]  J. Caffey,et al.  On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. , 1972, American journal of diseases of children.

[10]  A. Woolf,et al.  Injuries in children sustained in free falls: an analysis of 66 cases. , 1975, The Journal of trauma.

[11]  L. Thibault,et al.  Biomechanics of acute subdural hematoma. , 1982, The Journal of trauma.

[12]  Erik G. Takhounts,et al.  DEVELOPMENT OF IMPROVED INJURY CRITERIA FOR THE ASSESSMENT OF ADVANCED AUTOMOTIVE RESTRAINT SYSTEMS - II , 1999 .

[13]  R. Snyder,et al.  HUMAN TOLERANCES TO EXTREME IMPACTS IN FREE-FALL. , 1963, Aerospace medicine.

[14]  Joseph D. Bronzino,et al.  The Biomedical Engineering Handbook , 1995 .

[15]  Albert I. King,et al.  Literature review of head injury biomechanics , 1994 .

[16]  T A Gennarelli,et al.  The Shaken Baby Syndrome: A Clinical, Pathological, and Biomechanical Study , 1987 .

[17]  J. Adams,et al.  Fatal head injury in children. , 1989, Journal of clinical pathology.

[18]  J S Ruan,et al.  Coupling of a finite element human head model with a lumped parameter Hybrid III dummy model: preliminary results. , 1995, Journal of neurotrauma.

[19]  G. Stürtz,et al.  Biomechanical Data of Children , 1980 .

[20]  H. R. Lissner,et al.  Experimental studies on the relation between acceleration and intracranial pressure changes in man. , 1960, Surgery, gynecology & obstetrics.

[21]  Bal M. Mahajan,et al.  Public Playground Equipment: Impact Attenuation Performance of Surfaces Installed Under Playground Equipment. Draft. , 1978 .

[22]  K. Naunheim,et al.  Quantitation of impact attenuation of different playground surfaces under various environmental conditions using a tri-axial accelerometer. , 1993, The Journal of trauma.

[23]  T. Gennarelli Head injury in man and experimental animals: clinical aspects. , 1983, Acta neurochirurgica. Supplementum.

[24]  S. Margulies,et al.  Infant skull and suture properties: measurements and implications for mechanisms of pediatric brain injury. , 2000, Journal of biomechanical engineering.

[25]  M. Klauber,et al.  Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. , 1988, Journal of Neurosurgery.

[26]  C. W. Gadd Use of a weighted-impulse criterion for estimating injury hazard , 1966 .

[27]  L. Anderson,et al.  The Likelihood of Injuries When Children Fall Out of Bed , 1987, Journal of pediatric orthopedics.

[28]  J. Versace A Review of the Severity Index , 1971 .

[29]  John W. Melvin,et al.  Head impact response comparisons of human surrogates , 1979 .

[30]  Leonard Derek Martin Nokes,et al.  Use of the Gadd severity index in forensic medicine: a case study , 1995 .

[31]  H. Onusic,et al.  HIC (head injury criterion) and SI (severity index) of impacts with different pulse shapes , 1995 .

[32]  J Sahuquillo-Barris,et al.  Acute subdural hematoma and diffuse axonal injury after severe head trauma. , 1988, Journal of neurosurgery.

[33]  H Mellander HIC--the head injury criterion. Practical significance for the automotive industry. , 1986, Acta neurochirurgica. Supplementum.

[34]  R. Minns,et al.  NON‐ACCIDENTAL HEAD INJURY, WITH PARTICULAR REFERENCE TO WHIPLASH SHAKING INJURY AND MEDICO‐LEGAL ASPECTS , 1993, Developmental medicine and child neurology.

[35]  R. Nickel,et al.  DEVELOPMENTAL PROGNOSIS FOR INFANTS WITH BENIGN ENLARGEMENT OF THE SUBARACHNOID SPACES , 1987, Developmental medicine and child neurology.

[36]  A E Hirsch,et al.  Tolerances for cerebral concussion from head impact and whiplash in primates. , 1971, Journal of biomechanics.

[37]  M. Peck,et al.  The risk of childhood injury on Boston's playground equipment and surfaces. , 1993, American journal of public health.