{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:14:28Z","timestamp":1787750068777,"version":"build-2784847793"},"reference-count":54,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,6]],"date-time":"2023-05-06T00:00:00Z","timestamp":1683331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>A newborn girl had, from two weeks on, small bruises on varying body locations, but not on her chest. Her Armenian grandmother easily bruised, too. Her mother was diagnosed with hypermobility-type Ehlers-Danlos-Syndrome (hEDS), an autosomal dominant connective tissue disorder, with a 50% inheritance probability. Referral to a University Medical Center located \u201cDutch Expertise Center for Child Abuse\u201d resulted (prior to consultation) in physical abuse suspicion. Protocol-based skeletal X-rays showed three healed, asymptomatic rib fractures. A protocol-based Bayesian likelihood ratio guesstimation gave 10\u2013100, erroneously used to suggest a 10\u2013100 times likelier non-accidental-than-accidental cause. Foster care placement followed, even in a secret home, where she also bruised, suggesting hEDS inheritance. Correct non-accidental\/accidental Bayes\u2019 probability of symptoms is (likelihood ratio) \u00d7 (physical abuse incidence). From the literature, we derived an infant abuse incidence between about \u22480.0009 and \u22480.0026 and a likelihood ratio of &lt;5 for bruises. For rib fractures, we used a zero likelihood ratio, arguing their cause was birth trauma from the extra delivery pressure on the chest, combined with fragile bones as the daughter of an hEDS-mother. We thus derived a negligible abuse\/accidental probability between &lt;5 \u00d7 0.0009 &lt;0.005 and &lt;5 \u00d7 0.0026 &lt;0.013. The small abuse incidence implies that correctly using Bayes\u2019 theorem will also miss true infant physical abuse cases. Curiously, because likelihood ratios assess how more often symptoms develop if abuse did occur versus non-abuse, Bayes\u2019 theorem then implies a 100% infant abuse incidence (unwittingly) used by LECK. In conclusion, probabilities should never replace differential diagnostic procedures, the accepted medical method of care. Well-known from literature, supported by the present case, is that (child abuse pediatrics) physicians, child protection workers, and judges were unlikely to understand Bayesian statistics. Its use without statistics consultation should therefore not have occurred. Thus, Bayesian statistics, and certainly (misused) likelihood ratios, should never be applied in cases of physical child abuse suspicion. Finally, parental innocence follows from clarifying what could have caused the girl\u2019s bruises (inherited hEDS), and rib fractures (birth trauma from fragile bones).<\/jats:p>","DOI":"10.3390\/children10050843","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T03:34:53Z","timestamp":1683516893000},"page":"843","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Child Abuse, Misdiagnosed by an Expertise Center\u2014Part II\u2014Misuse of Bayes\u2019 Theorem"],"prefix":"10.3390","volume":"10","author":[{"given":"Martin J. C.","family":"van Gemert","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering & Physics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aeilko H.","family":"Zwinderman","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology & Bio-Statistics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J. van","family":"Koppen","sequence":"additional","affiliation":[{"name":"Department of Criminal Law and Criminology, Faculty of Law, VU University, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. A. Martino","family":"Neumann","sequence":"additional","affiliation":[{"name":"ZBC-Multicare, 1217 AB Hilversum, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Vlaming","sequence":"additional","affiliation":[{"name":"Private Practice, Criminal Psychology and Law, 6986 CL Angerlo, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,6]]},"reference":[{"key":"ref_1","unstructured":"Vlaming, M., Sauer, P.J.J., Janssen, E.P.F., van Koppen, P.J., Akkerman-Zaalberg van Zelst, M.W.M., Bruijninckx, C.A.M., Neumann, H.A.M., and van Gemert, M.J.C. (2023). Child Abuse, misdiagnosed by an Expertise Center. Part I. Medico-Social Aspects. 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