Functional time limit and onset of symptoms in infant abusive head trauma

Aim: To analyse medical and witness evidence collected during investigations of infant abusive head trauma with a view to (i) isolating cases where a functional time limit could be established and (ii) examining those cases for evidence of the onset of neurological symptoms. Methods: A retrospective study was undertaken of severe infant abusive head trauma cases investigated by the Queensland Police Service over a 10-year period. In cases where sufficient reliable (non-perpetrator) evidence was available, a functional time limit was documented. Those files were then examined for further medical, witness or perpetrator evidence of the infant victim's response to the assault. Results: A functional time limit was established in 16 of 52 cases (31%). In 11 of the 16 cases there was evidence of an immediate neurological response on the part of the victim. Conclusion: The study suggests that the period between assault and onset of symptoms in infant abusive head trauma is brief, particularly in cases of an acute deterioration where proximate medical intervention is required. In those cases with sufficient evidence of the victim's condition post-injury, the symptoms presented without delay.