Queens Head Injury Conference Opens the Door a Little Wider

This fall’s NYC Abusive Head Trauma/Shaken Baby Syndrome Conference, sponsored jointly by the Queens County District Attorney’s Office and the New York City Office of the Chief Medical Examiner, will feature some of the most outspoken proponents of shaken baby theory but also a few of the skeptics.

The conference, which is aimed at legal and medical professionals, costs only $25 and runs a day and a half, on September 17 and 18. The program will open with a history of traumatic brain injury by science writer Sam Kean, whose new book The Tale of the Dueling Neurosurgeons promises “true stories of trauma, madness, and recovery.”

Past Queens conferences have featured roundtable discussions that included critics as well as proponents of shaken baby theory, but this year’s schedule lists two full presentations from skeptics, one by attorneys Keith Findley of the Wisconsin Innocence Project and Adele Bernhard of the Post-Conviction Innocence Clinic, and one by pathologist Patrick Lantz, who has criticized the child abuse literature for adopting guidelines about retinal findings without objective scientific evidence.

Prof. Adele Bernhard

Attorneys Findley and Bernhard will be giving the Innocence Network perspective on appeals in infant head trauma cases—Findley spearheaded the appeal that freed child care provider Audrey Edmunds in 2008, and Bernhard argued last year at the successful hearing on behalf of care provider René Bailey. The prosecution perspective will come in a separate presentation by Deputy Executive Assistant District Attorney John Castellano and Senior Assistant District Attorney William Branigan, of the Queens County District Attorney Appeals Bureau. Both teams will address the topic “Enhancing Post-Litigation Accuracy.”

Dr. Lantz, a pathology professor at Wake Forest Baptist Health in North Carolina, is one of two speakers at the Queens conference scheduled to talk about retinal hemorrhages. The other is ophthalmology professor Brian J. Forbes at the University of Pennsylvania School of Medicine.

In 2004, Dr. Lantz published a case study and critical literature review in the BMJ that cautioned against relying on retinal findings when diagnosing abuse. He has since encouraged pathologists to gather more data by capturing retinal images in all child deaths, whether or not abuse is suspected.

Dr. Forbes is a co-author of a 2009 study that concluded:

Retinal hemorrhages are highly associated with abusive head trauma, particularly in children under age 6 months. Increasing retinal hemorrhage severity is correlated with increasing likelihood of abuse.(1)

The Queens speaker list also features law-school dean and professor Joëlle Moreno from the Florida International University College of Law, whose talk is titled “The Impact of Media Perspectives on Abusive Head Trauma Litigation.”  She also addressed that topic at the 2014 Denver conference sponsored by the National Center on Shaken Baby Syndrome, where she said:

[T]he public’s understanding of the science and law of abusive head trauma is coming principally from media coverage… of criminal trials… The problem is the trial and the appellate courts are confusing valid medical evidence with outlier opinions promulgated by a handful of interested defense witnesses who don’t treat children.

For more of Prof. Moreno’s thoughts on the controversy, see her 2013 law review article “Dissent Into Confusion: The Supreme Court, Denialism, and the False ‘Scientific’ Controversy Over Shaken Baby Syndrome,” co-authored with attorney Brian Holmgren.

Other Queens presenters include Dr. John M. Leventhal, who is on the faculty at the Yale University School of Medicine and on the advisory board of the National Center on Shaken Baby Syndrome, and Dr. Christopher Greeley, professor of pediatrics at the University of Texas Health Sciences Center at Houston. In a 2012 commentary in the journal Pediatrics, Dr. Greeley praised the meta-analyses that had recently been published by Piteau(2) and Maguire(3), in which the researchers pooled the findings of many individual child-abuse studies in an attempt to achieve statistically meaningful numbers. Greeley wrote at the time:

Both of these reports, using different search protocols and analyzing different data from the same body of literature, independently confirm the diagnostic precision of retinal hemorrhages, subdural hemorrhages, and rib fractures for abusive head trauma (AHT). By independently using different strategies on the same body of literature and demonstrating similar results, we see clear support for these clinical findings, which are often used in diagnosing AHT.(4)

(For a response from three physicians who question his conclusions, please see http://pediatrics.aappublications.org/content/130/2/347.full/reply#pediatrics_el_54511.)

In 2012, in a keynote address at the Twelfth International Conference on Shaken Baby Syndrome/Abusive Head Trauma, Dr. Greeley dismissed critics of shaken baby theory as child-abuse denialists who are manufacturing controversy where there is none.

I’m not sure how much common ground the various speakers are going to find at this fall’s conference, but I’m glad to see that the two sides are starting to appear on the same programs. For the conference agenda and registration form, follow this link.

(1) Binenbaum G, Mirza-George N, Christian CW, Forbes BJ. “Odds of abuse associated with retinal hemorrhages in children suspected of child abuse,” J AAPOS 2009 13(3):268–272. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712730/

(2) Piteau SJ, Ward MGK, Barrowman NJ, and Plint AC. “Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review,” Pediatrics 2012 130(2):315–323.  Available at http://pediatrics.aappublications.org/content/early/2012/07/03/peds.2011-1545.full.pdf

(3) Maguire SA, Kemp AM, Lumb, RC. “Estimating the probability of abusive head trauma: a pooled analysis,” Pediatrics 2011 128(3):e550–e564. Available at http://pediatrics.aappublications.org/content/128/3/e550.full

(4) Greeley CS. “The Evolution of the Child Maltreatment Literature,” Pediatrics 2012 130(2):347–348, available at http://pediatrics.aappublications.org/content/130/2/347.full#xref-ref-8-1