Unthinking empiricism and the overdiagnosis of nonlethal cranial injuries: An interdisciplinary review of diagnostic criteria for healing, depressed cranial fractures

The work examines how antemortem cranial injury is diagnosed in the literature in order to determine whether nonlethal trauma is being over-diagnosed in archaeology. While the majority of publications cite criteria for perimortem cranial fractures, none have adopted a clear set of criteria for diagnosing antemortem depressed fractures. This study systematically reviewed the relevant bioarchaeological, forensic, and paleopathological literature and identified ten criteria commonly used in diagnosing healing, depressed cranial fractures (HDCF). Bioarchaeological studies (n = 146) describing trauma were evaluated for the criteria used to diagnose HDCF. Results indicate that studies recording HDCF rarely consider > 2-3 criteria. The most commonly scored features, lesion shape (63%), size (63%) and location (91%), can only be considered consistent with HDCF. Features diagnostic of HDCF, retention of concentric or radiating fracture lines, were only mentioned in 1% and 7% of the studies respectively. Even more problematic were contradictions in how criteria were applied across studies. Unclear, ambiguous, inconsistent or absent diagnostic criteria for HDCL is potentially causing an overestimation of nonlethal violence in the archaeological record.