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Emphasizes conveying uncertainty to clinicians, avoiding presentation of injury mechanisms as validated science, and applying evidence-based medicine principles with graded evidence levels. Includes author contribution and competing interest 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is the main purpose of the letter regarding Abusive Head Trauma?","Question",{"text":63,"@type":64},"To call for transparency about diagnostic certainty in Abusive Head Trauma by endorsing Brook et al. and highlighting concerns about diagnostic uncertainty in this field.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why does the letter state that AHT has low diagnostic certainty?",{"text":68,"@type":64},"Because AHT diagnosis is described as complex and challenging, suffers from lack of consistent case definitions, and relies on clinical interpretation without a pathognomonic marker.",{"name":70,"@type":61,"acceptedAnswer":71},"What guidance does the letter provide for how clinicians should report diagnoses?",{"text":72,"@type":64},"Clinicians should attach the correct level of uncertainty, avoid presenting injury mechanisms as validated science, and apply evidence-based medicine principles with graded evidence 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\nForensic Science International: Synergy  \njournal [homepage:](homepage: www.sciencedirect.com/journal/forensic-science-international-synergy)[ www.sciencedirect.com/journal/forensic-science-international-synergy](homepage: www.sciencedirect.com/journal/forensic-science-international-synergy)  \nCall for transparency regarding diagnostic certainty in Abusive Head Trauma  \nTo the Editor,  \nWe, the undersigned, a large and diverse group of physicians and scientists representing pediatrics, pathology, neonatology, neurology, neuropathology, neurosurgery, biomechanics, and radiology, endorse the conclusions ofthe recent article by Brook et al.,“A Critical Review of the American Academy of Pediatrics Technical Report on Abusive Head Trauma.”  \nWe share the concerns surrounding diagnostic uncertainty in this critical field. Not all diagnoses or diagnostic methods carry the same level of certainty. The diagnosis of AHT, according to the AAP technical report itself, is “complex and challenging”, suffers from a lack of consistent case definition, and relies on interpreting clinical findings without a pathognomonic marker. This diagnosis therefore sits at the low end of diagnostic certainty in medicine.  \nWe recognize that child abuse occurs and that the experience of dedicated clinicians allows them to raise suspicion of abuse based on medical findings. The imperative to identify true abuse must then be fulfilled by independent investigation, including social services and police, searching for non-medical evidence of harm, while social services must monitor the family as appropriate, as well as provide support.  \nThe inherent uncertainty in the diagnosis and complex diagnostic methods ofAHT, and the weak science base highlighted by Brook et al., should be conveyed to clinicians, who should attach the correct level of uncertainty to their diagnoses. Clinical judgment regarding the mechanism of injury should not be presented as validated science, but as a medical opinion that carries significant uncertainty.  \nRigorous application of the principles of evidence-based medicine, including the grading of evidence levels, is essential to ensure that the diagnosis of AHT adheres to the highest principles of scientific integrity.  \nCRediT authorship contribution statement  \nRoland N. Auer: Writing – review & editing. Keith Button: Writing – review & editing. Stephen Cordner: Writing – review & editing. Johan Duflou: Writing – review & editing. Bernard Echenne: Writing – review & editing. Vineta Fellman: Writing – review & editing. Steven Gabaeff: Writing – review & editing. John Galaznik: Writing – review & editing. Saadi Ghatan: Writing – review & editing. Ulf H¨ogberg: Writing – review & editing. John C. Hunsaker: Writing – review & editing. William Lee: Writing – review & editing. Niels Lynøe: Writing – review & editing. Julie Mack: Writing – original draft. Evan Matshes: Writing – review & editing. Tommie Olofsson: Writing – review & editing. Matthew Orde: Writing – review & editing. Guillaume S´ebire: Writing – review & editing. James Tibballs: Writing – review & editing. Carola G. Vinuesa: Writing – review & editing. Knut Wester: Writing – review & editing. Ronald Wright: Writing – review & editing. Anna Ybo: Writing – review & editing.  \nDeclaration of competing interest  \nThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.  \nRoland N. Auer  \nRoyal University Hospital, Saskatoon, Saskatchewan, Canada  \nKeith Button  \nBiomechanics, Managing Engineer Explico Inc., Michigan, USA  \nStephen Cordner  \nForensic Medicine, Monash University, Australia  \nJohan Duflou  \nForensic Pathology, University of Sydney, Australia  \nBernard Echenne  \nMontpellier University, France  \nVineta Fellman  \nNeonatology, University of Helsinki, Finlan","cbCailHEHU6sMJNO","https://ap.wps.com/l/cbCailHEHU6sMJNO","pdf",332020,"English","# Call for transparency regarding diagnostic certainty in Abusive Head Trauma\n## Letter endorsement and concerns\n## Uncertainty communication and evidence-based grading\n## Authors, competing interest declaration, and correspondence","[{\"question\":\"What is the main purpose of the letter regarding Abusive Head Trauma?\",\"answer\":\"To call for transparency about diagnostic certainty in Abusive Head Trauma by endorsing Brook et al. and highlighting concerns about diagnostic uncertainty in this field.\"},{\"question\":\"Why does the letter state that AHT has low diagnostic certainty?\",\"answer\":\"Because AHT diagnosis is described as complex and challenging, suffers from lack of consistent case definitions, and relies on clinical interpretation without a pathognomonic marker.\"},{\"question\":\"What guidance does the letter provide for how clinicians should report diagnoses?\",\"answer\":\"Clinicians should attach the correct level of uncertainty, avoid presenting injury mechanisms as validated science, and apply evidence-based medicine principles with graded evidence levels.\"}]","Call for transparency regarding diagnostic certainty in Abusive Head Trauma | PDF",1790734286]