What Do Confessions Reveal about Abusive Head Trauma? A Systematic Review

Abstract

Although confessions related to abusive head trauma (AHT) are reported, no detailed analysis exists. Therefore, we systematically reviewed studies of AHT confessions and examined the details, including country of origin, mechanisms and perpetrators' characteristics. Employing 36 search terms across three search engines, we searched Medline and CINAHL from 1963 to 2018. All relevant studies underwent two independent reviews and data extraction. Descriptive statistics were used to characterise the sample; chi square and Fisher's exact tests were used to assess differences in demographic and clinical characteristics. Of 6759 identified studies, 157 full texts were reviewed and 55 articles from 15 countries spanning four continents were included. Included articles contained 434 confessions. The mechanisms of abuse included shaking alone (64.1%), impact alone (17.1%), shaking plus impact (18.0%) and other (0.9%). There was no statistically significant difference in the percentage of confessions reporting shaking alone when comparing continents: North America (64.0%), Europe (64.2%) and Oceania (60.0%; p = 0.92), or when comparing circumstances in which the confession was obtained: medical evaluation (74.6%) vs police or judicial investigations (63.4%; p = 0.11). Of 119 cases with identified perpetrators, 67.2 per cent were cases with males alone. Confessions reveal striking similarities in the mechanism of AHT (predominantly shaking) that occur across the globe. Key Practitioner Messages: Confessions can provide important information about AHT and have been reported in medical literature for over 40 years. The quality of evidence for the association of shaking with AHT has been questioned, but no systematic review of confessions of AHT has been performed previously. This systematic review of confessions of AHT reveals that shaking is the most common mechanism reported and that shaking and AHT occur together across the world. ‘We systematically reviewed studies of AHT confessions and examined the details, including country of origin, mechanisms and perpetrators' characteristics’.