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Inclusion criteria

We included comparative studies of abusive head trauma (AHT) and non-abusive head trauma (nAHT) with consecutive case ascertainment. We included AHT where the rank of abuse was 1 or 2. We looked for confirmation of non-abusive causes (trauma or medical). We excluded from the final analysis studies which included a category where the aetiology was ‘indeterminate’. To minimise selection bias and circularity, we did not include any studies where the decision of abuse had relied solely on clinical features.


See evidence sheets and critical appraisal forms for each year’s update.




children aged 0 years up to 18th birthday

studies about complications, management or prognosis of AHT / nAHT

observational comparative study (cross-sectional / case-control / case series / longitudinal cohort)

non-comparative studies

children with AHT

consensus statements or personal practice studies

ranking of abuse 1 or 2 for AHT

studies addressing exclusively post-mortem neuro-pathological findings

nAHT: non-abusive aetiology confirmed

studies with mixed adult and child data, where the children’s data cannot be extracted

children who were alive at presentation

methodologically flawed studies (e.g significant bias, where AHT was not adequately confirmed or where inadequate clinical details were given)

all language studies

studies that only addressed head injury where there was no intracranial abnormality

relevant clinical details given for each group

studies with low surety of diagnosis of abusive injury (rank 3-5 abuse)


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