Shaken baby syndrome

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We would like to thank to Dr Ludvigsson (1), who was the only critical commentary author to acknowledge the methodological problems inherent in the diagnosis of shaken baby syndrome, following the publication of our systematic review (2) in Acta Paediatrica. Dr Ludvigsson posed two questions regarding the two main conclusions, which deserve responses. This article is protected by copyright. All rights reserved.

Narang et al (1) maintain that the research question in our systematic review in Acta Paediatrica (2) was based on the findings of Guthkelch in 1971 (3), and that we presumed that Guthkelch introduced the shaken baby syndrome triad. That is not correct. We used the Guthkelch example in the introduction in order to illustrate when the discussion on shaken baby syndrome was initiated. As our research question was a reverse causality version of the Guthkelch hypothesis, it was not influenced by that hypothesis...

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The paper by Lynøe et al (1) summarises a systematic review carried out by the Swedish Agency for Health Technology Assessment (2), including the conclusion that there was insufficient evidence to assess the diagnostic accuracy of the triad in identifying traumatic shaking. Concerns regarding the methodological weaknesses of the Agency's report have been highlighted by a number of commentators, including one of our co-authors (AS-P) (3). This Different View draws attention to what Lynøe et al stated about possible alternative explanations of the triad, based on Appendix 1 of the Agency report (2) (Table 1), which is cited in the Lynøe et al paper (1)...

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Lynöe et al is an adjunct to a larger report by the Swedish Agency For Health Technology Assessment And Assessment Of Social Services ("SBU") entitled "Traumatic shaking - The role of the triad in medical investigations of suspected traumatic shaking" (1). Lynoe et al purports to rigorously, objectively, and transparently examine the evidence-based medical literature on Shaken Baby Syndrome (SBS) under well-established guidelines of systematic reviews (2). And, having done so, it concludes that there is "very low" scientific evidence supporting the premise that the "triad" implies that an infant has been violently shaken, and "low" scientific evidence supporting the assumption that shaking an infant causes the triad...

In this issue of Acta Paediatrica, Professor Alex Levin, Director of the Pediatric Ophthalmology and Strabismus Service at Wills Eye Hospital, (PA, USA), expresses relevant concerns (1) about a report produced by the Swedish Agency for Technology Assessment of Health and Social Services (SBU) (2) and summarized in a paper by Lynøe et al (3). He also provides necessary input on the importance of the morphology and distribution of retinal hemorrhages in diagnosing different causes of retinal bleedings. SBU undertakes independent assessments of methods used in health, medical, dental and social services and services provided to persons with certain functional disabilities...

Shaken baby syndrome has typically been associated with findings of subdural haematoma, retinal haemorrhages and encephalopathy, which are referred to as the triad. During the last decade, however, the certainty with which the triad can indicate that an infant has been violently shaken has been increasingly questioned. The aim of this study was to determine the diagnostic accuracy of the triad in detecting that an infant had been shaken. The literature search was performed using PubMed, Embase and the Cochrane Library up to October 15, 2015...

The combination of subdural hemorrhage (SDH), retinal hemorrhage (RH), and encephalopathy, or the presence of severe retinal hemorrhages alone in infants, is often attributed to and has been stated to be pathognomonic for abusive head trauma (AHT) or shaken baby syndrome. These beliefs have been challenged, because the same constellation of findings has been identified in accidental head injuries and natural diseases, and most if not all of the studies that support the concept of diagnostic specificity have serious flaws in their methodology...

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Abusive head trauma (AHT) is a serious form of child maltreatment that needs to be prevented. The aim of this study was to summarize the main AHT prevention strategies described in literature, aiming to identify evidence of their efficiency, as well as strengths and limitations. International databases were reviewed from 2005 to 2015 using the key words Shaken Baby Syndrome or abusive head trauma or nonaccidental head trauma or abusive head injury or nonaccidental head injury and prevention A total of 1,215 articles were found and 34 complete articles were selected for this study...

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No abstract text is available yet for this article.

INTRODUCTION: Even if there are HAS (French National Health Authority) guidelines on shaken baby syndrome, many other child abuse situations are not included in these recommendations. The aim of this study was to invent the complementary exams in cases of child abuse in France and compare the practice to existing guidelines. MATERIAL AND METHODS: This was a multicenter study by email to 128 French hospitals (35 university hospitals and 93 general hospitals) that receives children in emergency and hospitalization settings...

UNLABELLED: Brain stiffness plays an important role in neuronal development and disease, but reported stiffness values vary significantly for different species, for different brains, and even for different regions within the same brain. Despite extensive research throughout the past decade, the mechanistic origin of these stiffness variations remains elusive. Here we show that brain tissue stiffness is correlated to the underlying tissue microstructure and directly proportional to the local myelin content...

OBJECTIVE: To assess the current general acceptance within the medical community of shaken baby syndrome (SBS), abusive head trauma (AHT), and several alternative explanations for findings commonly seen in abused children. STUDY DESIGN: This was a survey of physicians frequently involved in the evaluation of injured children at 10 leading children's hospitals. Physicians were asked to estimate the likelihood that subdural hematoma, severe retinal hemorrhages, and coma or death would result from several proposed mechanisms...

BACKGROUND: Shaken Baby Syndrome (SBS), currently functioning as Abusive Head Trauma (AHT), is a form of violence against children mainly under 2 years of age. The number of SBS might be underestimated, as many cases of violence remain unreported. The aim of the study was evaluation of the state of knowledge of the SBS phenomenon, its scale and diagnostic methods among parents, medical staff and medical students. METHODS: 639 people were examined: 39% of parents, 32,5% medical staff members and 28,5% of medical students...