Answer to Lynøe: Interesting data about confessions and abusive head trauma, but suboptimal analysis

Agreements and disagreements regarding “shaken baby syndrome”

“…We agree with some of the statements by Vinchon et al [ 1 ], e.g., that (i) circular reasoning is associated with a high risk of bias in diagnostic accuracy studies and that (ii) confession studies might represent a possibility to avoid a high risk of bias through circular reasoning—if the confessions are documented, reliable, detailed, and not associated with pressure from the judicial system.…”

“…Hence, Vinchon et al completely ignore scientific standards when they "(base) the diagnosis of AHI …on medical findings alone." [1].…”

“…Furthermore, in opposition to the well-founded second conclusion of the SBU report that "there is 'limited' scientific evidence that the triad and therefore its components can be associated with traumatic shaking," Vinchon et al flippantly "strongly disagree with this conclusion" by referring to a handful of cherry-picked-but not quality assessed-references, and to deceptive and undefined "clinical experience"-where the clinician never has access to the "true explanation" of the medical findings. Obviously, the authors [1] are not familiar with the GRADE terminology [9] and, in practice, now seem to ignore the detrimental effects of circular reasoning in previous SBS research [6].…”

“…Revealing the serious flaws of the never proven traditional SBS theory [6] can of course never "undermine prevention measures for this severe, avoidable and thus unacceptable condition…." [1] On the contrary, scientifically valid conclusions must be based on evidence and never upon such obviously value-based goals. Pediatric practitioners must therefore learn to accept the different requirements upon clinical work versus scientific work and upon clinical work versus the task of a medico-legal expert.…”

“…Still a few important issues must, however, be discussed further in relation to the statements by Vinchon et al [ 1 ] and the deep scientific controversy regarding “shaken baby syndrome.”…”