What is a paediatric neuroradiologist?
Paediatric neuroradiologists are radiologists who specialise in neuroimaging of children. Radiologists are doctors who use images to diagnose, treat and manage medical conditions and diseases. With the national shortage of radiologists, some centres rely on non-specialist radiologists to undertake specialist paediatric work. This is a significant problem to the specialty because many non-specialists may not have seen the volume of cases that their specialist colleagues have done, and their training, particularly in the diagnosis of physical abuse in children, is often lacking.
Assessing suspected physical abuse in children
Using radiological images to assess suspected physical abuse in children is a highly specialist skill and requires nuanced interpretation and the recognition of normal variants. There are, of course, no gold standards for the diagnosis of physical abuse and the imaging features which might constitute a head injury found in a child who has been subject to physical abuse are variable, or otherwise called abusive head injuries. Therefore paediatric neuroradiologist expert witnesses must be able to recognise accidental trauma, non-accidental injuries and related differential diagnoses.
Findings which may indicate abusive head injury in children include skull fractures and extra-axial haemorrhage (a subtype of intracranial haemorrhage, or bleeding within the intracranial space, that occurs within the skull but outside of the brain tissue itself), along with conditions which mimic such phenomena. There are also parenchymal (the functional tissue in the brain) findings which include hypoxic–ischaemic damage (damage caused when the brain doesn’t receive enough oxygen or blood flow for a period of time), clefts (lacerations), contusion (bruises) and focal haemorrhage.
Consequences of abusive head injuries in children
Although abusive head injuries may cause death, survival may be associated with significant and life-changing outcomes. There is the risk of gross motor and cognitive impairment, behavioural problems, loss of vision, and epilepsy. Children who sustain abusive head injuries are likely to require additional physical care and in many cases, additional emotional and mental health support. A study from 2021, estimates the incidence of abusive head trauma to be approximately 35 cases per 100,000 infants. Approximately 65% of children who sustain abusive head trauma have significant neurological disabilities. The risk of death is significant: between 5 and 35% of infants die from the injuries they sustain.
What other expert witnesses may be instructed alongside paediatric neuroradiologist expert witnesses?
In family proceedings, cases of suspected physical abuse often require the specialist knowledge of more than one expert witness. Other experts such as paediatrician expert witnesses and ophthalmologist expert witnesses may be commissioned to provide evidence. The findings of paediatric neuroradiologist expert witnesses are likely to be interpreted alongside other investigation findings such as blood results, and in the context of the assessments of social workers from Local Authority Children and Family Services.
What experts does Expert Court Reports have?
We are fortunate to have a highly-respected paediatric neuroradiologist expert witness on our panel. Dr Kshitij Mankad is an expert in his field and is the Clinical Lead for Paediatric Neuroradiology at Great Ormond Street Hospital for Children. He also provides services for University College London Hospital and several private paediatric hospitals in the city of London. He has published over 170 papers in peer-reviewed journals and has established experience of acting as an expert witness.
Why use Expert Court Reports?
Proficient paediatric neuroradiologist expert witnesses should come with years of clinical experience. Unless the expert has experienced thousands of “normal studies”, their ability to interpret the radiological evidence to give opinions in suspected physical abuse will be compromised. Paediatric neuroradiologist expert witnesses should also have specific competencies to act as an expert witness. Look for someone who has established expert witness experience. Our expert, Dr Kshitij Mankad, is eminently qualified and proficient in his work.
How quickly can you provide a report?
At Expert Court Reports Ltd, we understand the pressures of the legal profession. We recognise that litigation is subject to defined timescales and for this reason, we will be as flexible and accommodating as we are able to be. However, we pride ourselves on not promising work that cannot be reliably delivered within a given timescale. The quality of the evidence which is provided by our experts is subject to review and scrutiny. All expert reports are subject to a detailed and robust proofreading process to ensure that our expert evidence is accurate and expertly formatted.