Experimental modelling of imposed upper airway obstruction in infants and children
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ORIGINAL ARTICLE
Experimental modelling of imposed upper airway obstruction in infants and children George Johnson 1 & Frederick Green 2 & Harriet Clift 3 & Christopher Paul Johnson 4 Accepted: 3 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The interpretation of injuries to children and infants poses a number of difficulties to any medical practitioner involved in their care or tasked with the investigation their death. This includes differentiating accidental from non-accidental trauma and the consideration of medical factors making a child more prone to injury. Non-fatal but life-threatening upper airway obstruction is unfortunately a well-recognized pattern of abuse which may precede a fatal episode. In this experimental study, we aimed to model theoretical digit marks to the head using infant and young child resuscitation dummies, exposed to various methods of deliberate upper airway obstruction. This work has demonstrated that digit marks can be left anywhere on the head and face. However, the distribution of these marks varies dramatically based on how the airway was obstructed. Moreover, digit marks also appeared to be linked together in fairly reproducible patterns. Given the findings in this study, the identification of one or more fingertip type bruises anywhere on an infant or child’s face or scalp, should raise the index of suspicion that the individual may have been subject to deliberate upper airway obstruction. This should prompt healthcare professionals to examine the child for markers of mechanical asphyxia, in order to accurately interpret any inadequately explained bruising to the head and face. Keywords Airway obstruction . Asphyxia . Bruising . Child abuse . Experimental modelling . Homicide
Introduction The interpretation of injuries to children and infants poses a number of difficulties to any medical practitioner involved in their care or tasked with the investigation of their death. This includes differentiating accidental from non-accidental trauma and the consideration of medical factors making a child more prone to injury, such as abnormalities in the coagulation
* George Johnson [email protected] 1
Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, Merseyside L9 7AL, UK
2
The Whittington Hospital, Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK
3
The Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
4
Department of Forensic Pathology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK
cascade, platelet function and inherited bone disorders. Some cases of non-accidental injury are less difficult to identify, particularly when a number of injuries such as metaphyseal corner, posterior rib and scapula fractures are present without an adequate explanation [1]. However, often injuries are not so easy to inte
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