Introduction

Good practice guidelines help clinicians to establish a suspected diagnosis of non-accidental head injury (NAHI) and help forensic experts to establish a level of certainty for the diagnosis.

The objective of this study was to assess how the French Health Authority (HAS) guidelines contribute to the process of producing an expert assessment, on causation and certainty in cases of suspected NAHI.

Method

A retrospective study was conducted of the expert assessments that were conducted by a paediatric surgeon and forensic expert attached to our local court between 2002 and 2018, with the aim of determining the causal mechanism of the lesions and express a degree of certainty regarding the diagnosis.

Results

In our study, we found that, despite the HAS guidelines, a number of documents deemed essential for the forensic expert were sometimes missing, and that, by applying these guidelines, the decisions reached in some expert assessments could been reclassified and certain factors formerly described as risk factors for injury could be excluded. A precise dating of the traumatic event was proposed in half of cases.

Conclusion

Our study highlights the vital role of the HAS guidelines, not only for patient management but also to ensure high-quality expert assessments. Unfortunately, guidelines were not yet being properly adhered to by medical teams.

中文翻译：

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婴儿非意外头部外伤案件的司法处理：专家评估的审查和分析

介绍

良好实践指南可帮助临床医生确定非意外头部损伤 (NAHI) 的疑似诊断，并帮助法医专家确定诊断的确定性水平。

本研究的目的是评估法国卫生局 (HAS) 指南如何促进对疑似 NAHI 病例的因果关系和确定性进行专家评估的过程。

方法

对 2002 年至 2018 年间由当地法院的儿科医生和法医专家进行的专家评估进行了回顾性研究，目的是确定病变的因果机制并表达对诊断的一定程度的确定性。

结果

在我们的研究中，我们发现，尽管有 HAS 指南，但有时会丢失一些被认为对法医专家至关重要的文件，并且通过应用这些指南，可以对某些专家评估中达成的决定进行重新分类，并且以前描述的某些因素因为可以排除伤害的危险因素。在一半的案例中提出了创伤事件的精确日期。

结论

我们的研究强调了 HAS 指南的重要作用，不仅对于患者管理，而且对于确保高质量的专家评估。不幸的是，医疗团队尚未正确遵守指导方针。