Age-diagnostics of subdural indicators of the shaken baby syndrome

通过一个全面的、新颖的、回顾性的队列研究，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可能是硬膜下积液（SDC）年龄诊断的标准。此外，该项目侧重于调查稀疏考虑的参数，以其适合年龄诊断。设想的研究项目的科学计划包括以下具体目标：BVT是SDC演化早期现象假说的验证。这首先需要确定BVT病例。随后，BVT的年龄估计应该通过既定的方法来完成（众所周知的SDH分期，通过系列神经影像学验证，通过犯罪者的供词验证）。(2)。开发一种新的、面向实际的类别或阶段系统，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，旨在研究它们随时间的演变；因此，发现法医相关的变化。验证最小密度差异（以霍恩斯菲尔德单位测量）的假设提供了区分SDH和慢性SDH （cSDH）的可能性。为此，必须建立一个以脑脊液样sdc为特征的研究队列亚群。在年龄诊断适宜性的情况下，该标准应包括在目标1中。2(4)。验证最初在成人中开发的SDHy分类系统也可用于婴幼儿的假设。为此，必须建立一个仅以SDHys为特征的研究队列亚群。在年龄诊断适宜性的情况下，该标准应包括在目标1中。2. 这首先包括上述分类系统对婴儿的应用。其次，要对其适用性和实用性进行评估。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病例工作的实际状态。一方面，这允许目标1的支持。2 .通过独立于神经影像学的参数。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.