At a diagnostic management team meeting in the late 1990s, I was presented with the case of an infant who developed a subdural hematoma. Her father was accused of shaking her to produce the hematoma; despite his defense that a minor fall had caused the observed bleeding, he was convicted of child abuse and imprisoned. Later, the same patient came to my institution – this time with meningitis. Our expert DMT clearly showed that she suffered from a common bleeding disorder known as von Willebrand disease, a diagnosis that had been missed during the previous evaluation because of a flawed interpretation of the lab test results. The fall the father had described in his defense could indeed have produced the subdural hematoma in a child with an underlying bleeding disorder. After two years in prison because of a diagnostic error, he was finally released.
A subsequent case arose when an attorney read about the first story and contacted me about his client. Again, a child had suffered a subdural hematoma – and, as in the previous case, our DMT found that he and both of his siblings had severe, previously undiagnosed von Willebrand disease. Since that time, I have been involved in more than 30 cases associated with a question of child abuse. Approximately five percent of cases of bruised children turn out to be child abuse mimics, rather than true child abuse. Such patients require a thorough coagulation evaluation to determine whether a bleeding disorder is present. I am pleased to say that, in all but two cases in which I have explained a bleeding disorder to a judge or jury in support of falsely accused caregivers, the child has been returned to a loving home. To me, this is the perfect illustration of the need for DMTs – a team of diagnostic professionals can look at something like suspected child abuse, find evidence of a bleeding disorder that might otherwise have been missed, and realize, “Holy cow! This was not child abuse at all. It was an underlying disease.”
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