Medical findings and symptoms in infants exposed to witnessed or admitted abusive shaking: A nationwide registry study

Thiblin, Ingemar; Andersson, Jacob; Wester, Knut; Wikström, Johan; Högberg, Göran; Högberg, Ulf

doi:10.1371/journal.pone.0240182

Cited by 18 publications

(23 citation statements)

References 44 publications

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“…With a systematic approach, including the less severe cases, overall morbidity is less than previously reported [41]. As mentioned above, shaking does not always cause SDH [42], and children have often been repeatedly shaken, with little visible effect, until they present with clinically overt lesions [43].…”

Section: Fake News 9: All Sbs Are Severe and If The Child Is Fine It Cannot Be Sbsmentioning

confidence: 90%

“…The term "hematoma" can thus be misleading regarding traumatic pericerebral collections in infants. This led several authors to prefer terms like hydroma, or hygroma [2,42,45,46], and amalgamate these loosely defined entities with expanded arachnoid spaces (arachnoidomegaly). Young infants around three months regularly develop arachnoidomegaly, which regresses before 2 years, suggesting an age-specific hydrodynamic imbalance [10].…”

Section: Fake News 10: If There Are No Clots This Is Not a Hematomamentioning

confidence: 99%

“…Several authors contest the validity of confessions because they consider these to be extorted or used as a token in pleabargain [2,42,46,51]. Some even accuse the prosecution of duress, deceit, and subterfuge in order to obtain confessions [7].…”

Section: Fake News 12: Confessions Of Shaking Are Invalidmentioning

confidence: 99%

“…Some confusion arises from different conceptions in pathophysiology and nosology and is reflected in the terminology. Several authors use terms like hydroma, or hygroma [2,42,45]; however, these terms have no widely admitted definition: "hygroma" originally designates "a cystic tumor of lymphatic origin" (the Merriam-Webster dictionary). We think the use of such vague and ambiguous terms should be avoided.…”

Section: Pathophysiology and Nosologymentioning

confidence: 99%

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The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news

2021

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Background The shaken baby syndrome (SBS) is a common cause of severe traumatic lesions in infants. Although well established for almost five decades, SBS and its diagnosis are becoming more and more aggressively challenged in courts. These challenges feed on the scientific debate and controversies regarding the pathophysiology and the differential diagnoses, scientific uncertainty being readily exploited by specialized barristers. Material and methodsIn the present review, we analyze the most common challenges to the concept of SBS and its diagnosis, as well as the scientific evidence available to counter these challenges, the differential diagnoses, and how SBS can be diagnosed with confidence. Results We found that the pathophysiology of SBS is well documented, with stereotyped descriptions by perpetrators, in good correlation with experimental studies and computer models. SBS is a well-defined clinico-pathological entity with a characteristic constellation of lesions; with a rigorous evaluation protocol, its diagnosis can be made rapidly and with excellent accuracy beyond a reasonable doubt. Conclusion It is important that medical experts master an extensive knowledge regarding the pathophysiology of the lesions of SBS, in particular infantile subdural hematomas, as well as other CSF-related conditions. This emphasizes the role that pediatric neurosurgeons should play in the clinical and medicolegal management of these patients.

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Section: Fake News 9: All Sbs Are Severe and If The Child Is Fine It Cannot Be Sbsmentioning

confidence: 90%

Section: Fake News 10: If There Are No Clots This Is Not a Hematomamentioning

confidence: 99%

Section: Fake News 12: Confessions Of Shaking Are Invalidmentioning

confidence: 99%

Section: Pathophysiology and Nosologymentioning

confidence: 99%

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The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news

2021

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“…This calls a causal association between shaking and the diagnostic criteria for SBS/AHT into question. There is also a possibility that the mental vaccination campaign was ineffective for prevention of traumatic shaking, since healthcare-seeking of witnessed or admitted shaking may actually have increased during the campaign period [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Transfer of knowledge to diagnose infant abuse and its incidence – a time-series analysis from Sweden

Högberg

2022

Implementation Sci

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Aim To analyse the transfer of knowledge on how to detect physical abuse, especially shaken baby syndrome/abusive head trauma (SBS/AHT), and its association to trends in infant abuse diagnoses (maltreatment and assault). Methods Design: retrospective population-based and quasi-experimental. Setting: Sweden 1987–2019. Patients: Children below age 1 year, selected from the National Patient Register (n = 1150). Exposures: Literature search for transfer of knowledge by diffusion, dissemination and implementation, and whether supportive or disruptive of the SBS/AHT paradigm. Main outcome measure: Abuse diagnoses (maltreatment or assault). Analyses: Incidence rate, incidence rate ratio (IRR). Results The overall incidence rate of abuse was 32.23 per 100,000 during the years 1987–2019. It was rather stable 1987–2000. The SBS diagnosis was introduced in the late 1990s. A comprehensive increase of transfer of knowledge on physical abuse, specifically on SBS/AHT and dangers of shaking, took place from 2002 and onward through diffusion, dissemination and implementation. Maltreatment diagnoses, but not assault diagnosis, increased steeply during 2002–2007, peaking in 2008–2013 [IRR 1.63 (95% confidence interval 1.34–1.98)]. Transfer of disruptive knowledge on SBS/AHT during the period 2014–2019 was associated with a decline in maltreatment diagnoses [IRR 0.84 (95% confidence interval 0.71–0.99)]. Conclusion An increase in maltreatment diagnoses was associated with transfer of supportive knowledge of the SBS/AHT paradigm, while a decline occurred toward the end of the study period, which might indicate a burgeoning de-implementation process.

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Abusive head trauma follows witnessed infant shaking

et al. 2022

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Abuse is a frequent cause of infant subdural haemorrhages, retinal haemorrhages and neurological dysfunction. Confessed shaking, without impact, is one reported injury cause. However, this remains legally controversial. We evaluated whether witnessed shaking alone can cause typical abusive head trauma (AHT). Cases were collected by Helfer Society list-serve solicitation for infants who developed signs and symptoms of AHT after independently witnessed shaking. We also reviewed a cross-sectional observational, multicentre study (Examining Siblings to Recognize Abuse (ExSTRA)) of 2890 children evaluated for abuse between January 2010 and April 2011 who experienced independently witnessed shaking. Four children identified by the Helfer Society experienced witnessed shaking and developed clinical and radiological evidence of AHT, including subdural and retinal haemorrhages. Another two had neurological symptoms, but normal imaging. Nineteen (0.7%) ExSTRA subjects experienced witnessed shaking without impact injuries. Among them, one (5.9%) of the 17 subjects who were neuroimaged had AHT findings and additional abusive injuries. Three had neurologic symptoms but normal neuroimaging. Although shaking is rarely witnessed, these cases support that shaking alone can cause typical AHT injuries, including, but not limited to, acute neurological impairment, subdural haemorrhages and retinal haemorrhages. This information is important to the legal management of abused children. K E Y W O R D S abusive head trauma, child abuse, infant shaking, subdural haemorrhage Key Practitioner Messages• Confessions document that infant shaking can cause abusive head trauma (AHT); however, this is disputed in courtrooms and by some physicians. • Ten infants developed clinical neurologic symptoms with or without radiologic findings of AHT after independently witnessed shaking. None had a history of cranial impacts, and all lacked physical findings suggesting impacts. They provide support for isolated shaking as a cause of AHT.

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Medical findings and symptoms in infants exposed to witnessed or admitted abusive shaking: A nationwide registry study

Cited by 18 publications

References 44 publications

The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news

The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news

Transfer of knowledge to diagnose infant abuse and its incidence – a time-series analysis from Sweden

Abusive head trauma follows witnessed infant shaking

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