Age-diagnostics of subdural indicators of the shaken baby syndrome

通过一个全面、新颖和回顾性的研究队列，设想的研究项目旨在验证我们研究组最近获得的关于硬膜下水瘤(SDHy)和桥性静脉血栓(BVT)的新知识。根据这些数据，SDHy和BVT可作为诊断硬膜下积液(SDC)年龄的标准。此外，该项目的重点是调查稀少考虑的参数是否适用于年龄诊断。设想的研究项目的科学计划包括以下具体目标：(1)BVT是SDC演化的早期现象的假说的验证。这首先需要确定BVT病例。随后，应通过既定的方法(众所周知的SDH分期、连续神经成像核实、肇事者供认核实)来估计BVT的年龄。(2)开发一种新的、实用的分类或分期系统，反映SDC的年龄，并考虑不同的硬膜下参数，如新膜、BVT、生长行为和密度差异。对于这些参数的评估，其目的是研究它们随时间的演变；从而揭示与取证相关的变化。验证假设，即密度的微小差异(以Hounsfield单位测量)提供区分SDHy和慢性SDH(CSDH)的可能性。为此，必须建立以脑脊液样SDCs为特征的研究队列的亚群。在适合于年龄诊断的情况下，该标准应包括在目标2中。验证最初在成人中发展的SDHy分类系统可能也适用于婴儿和幼儿的假设。为此，必须建立一个仅以SDHys为特征的研究队列的子群体。在适合年龄诊断的情况下，这一标准应包括在目标2中。这首先包括对婴儿应用上述分类系统。其次，要评估其适宜性和实用性。通过收集非放射学和元数据，旨在概述德国摇晃婴儿综合征病例工作的实际情况。一方面，这允许通过独立于神经成像的参数来支持目标2。另一方面，Minns和Busuttil提出的临床-放射学分类系统的适用性和相关性可以分别与迄今未考虑的参数(新膜、BVT、生长行为)进行验证和关联。

By means of a comprehensive, novel, and retrospective study cohort, the envisaged research project aims at verifying the new knowledge on subdural hygromas (SDHy) and bridging vein thromboses (BVT), that has recently been gained in our study group. According to these data, SDHy and BVT may be criteria for age diagnostics of subdural collections (SDC). Furthermore, the project focuses on the investigation of sparsely considered parameters as to their suitability for age diagnostics. The scientific program of the envisaged research project comprises the following concrete objectives:(1.) Verification of the hypothesis that BVT are early phenomena in the evolution of SDC. This first requires the identification of BVT cases. Subsequently, age estimation of the BVT should be done by means of established approaches (well-known SDH stages, verification by serial neuroimaging, verification by confessions of perpetrators). (2.) Development of a novel, practically oriented category or stage system reflecting the age of SDC and considering different subdural parameters such as neomembranes, BVT, growth behavior and differences in density. For the assessment of these parameters, it is intended to study their evolution over time; thereby, uncovering forensically relevant changes.(3.) Verification of the hypothesis that minimal differences in density (measured in Hounsfield units) provide a possibility to distinguish SDHy from chronic SDH (cSDH). To this end, a sub-population of the study cohort must be established that is characterized by cerebrospinal fluid-like SDCs. In case of suitability for age diagnostics, this criterion should be included in objective no. 2.(4.) Verification of the hypothesis that SDHy classification systems originally developed in adults may also be available in infants and young children. To this end, a sub-population of the study cohort must be established that is characterized by SDHys only. In case of suitability for age diagnostics, this criterion should be included in objective no. 2. This comprises first the application of the mentioned classification systems on infants. Second, the suitability and practicability should be evaluated.(5.) By collecting non-radiologic and meta data, it is intended to outline the actual state of case work of shaken baby syndrome cases in Germany. On the one hand, this allows for the support of objective no. 2 by means of parameters that are independent of neuroimaging. On the other hand, the suitability and relevance of the clinico-radiological classification system proposed by Minns and Busuttil can be verified and correlated with so far unconsidered parameters (neomembranes, BVT, growth behavior), respectively.