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Misshandlungsbedingte Kopfverletzungen und Schütteltrauma-Syndrom

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Kindesmisshandlung

Zusammenfassung

Misshandlungsbedingte Kopfverletzungen haben die gravierendsten Auswirkungen aller Misshandlungsformen, d. h. die höchste Morbidität und Mortalität. Nach amerikanischen Schätzungen sind 80 % der Todesfälle durch ZNS-Verletzungen im Säuglingsalter auf Misshandlungen zurückzuführen. Insgesamt sind sie mit 66–75 % die häufigste misshandlungsbedingte Todesursache und die häufigste Säuglingstodesursache im 2. Lebenshalbjahr. Bei einer bislang hohen Variabilität der Terminologie ist „Abusive Head Trauma“ (AHT) mittlerweile der international empfohlene und anerkannte Begriff, während im deutschen Sprachraum weiterhin eher vom Schütteltrauma-Syndrom gesprochen wird (STS). Als charakteristische Konstellation beim klassischen Schütteltrauma-Syndrom wird die Koinzidenz einer variablen, oft aber schweren und prognostisch ungünstigen diffusen Hirnschädigung (Enzephalopathie) mit subduralen Hämatomen und meist ausgeprägten retinalen Blutungen beschrieben. Kennzeichnend sind dabei in der Regel fehlende oder nur subtile äußerlich sichtbare Verletzungen. Trotz des hochgradigen Hinweischarakters dieser klassischen „Trias“ sollte der Begriff insbesondere im juristischen Kontext als Grundlage der Diagnose vermieden werden. Die Diagnose beruht auf einer gründlichen Bewertung aller anamnestischen, klinischen, radiologischen und ophthalmologischen Befunde, unter Berücksichtigung der relevanten Differenzialdiagnosen. Am Ende des diagnostischen Prozesses wird nach Empfehlung der AWMF S3+ Kinderschutzleitlinie in einem multiprofessionellen Bewertungsprozess unter Berücksichtigung der o.g. Faktoren die Diagnose mit medizinischer Gewissheit gestellt. Kontroversen zum Konzept des Schütteltraumas müssen bekannt sein. Prognostisch kommt es in etwa jeweils einem Drittel zu schweren, mittleren oder leichten bzw. fehlenden Folgeschäden.

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Authors and Affiliations

  1. Ärztliche Kinderschutzambulanz, Klinikum Kassel GmbH Kinderklinik, Kassel, Deutschland

    Bernd Herrmann

  2. Universitätsklinikum Gießen Inst. Rechtsmedizin, Gießen, Deutschland

    Reinhard B. Dettmeyer

  3. Institut für Rechtsmedizin, Universität zu Köln, Medizinische Fakultät und Uniklinik, Köln, Deutschland

    Sibylle Banaschak

  4. Kinder- und Jugendmedizin, Universität zu Lübeck Kinder- und Jugendmedizin, Lübeck, Deutschland

    Ute Thyen

Authors
  1. Bernd Herrmann
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  2. Reinhard B. Dettmeyer
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  3. Sibylle Banaschak
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  4. Ute Thyen
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Correspondence to Bernd Herrmann .

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Herrmann, B., Dettmeyer, R.B., Banaschak, S., Thyen, U. (2022). Misshandlungsbedingte Kopfverletzungen und Schütteltrauma-Syndrom. In: Kindesmisshandlung. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-62417-3_3

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