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

Abstract

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.

Educational interventions to prevent paediatric abusive head trauma in babies younger than one year old: A systematic review and meta-analyses

“…We extracted outcome data for 16 studies: ten were RCTs (Arshadi, Mostafa, & Saiedi, n.d.;Barr et al, 2009a;Barr, Rivara, Barr, et al, 2009b;Bishe, Aziznejadroshan, Mojaveri, Hajiahmadi, & Bishe, 2020;Cala, Kelly, Ramos, VanVleet, & High, 2020;Fujiwara et al, 2012;Fujiwara, Isumi, Sampei, et al, 2020a;Groisberg et al, 2020;Lou, D'Souza, Chen, & Barr, 2011;McRury & Zolotor, 2010), including one cluster-RCT (Fujiwara et al, 2020a). Of the six NRSs, three were state/region-wide controlled before-and-after (CBA) studies (Dias, Rottmund, Cappos, et al, 2017;Vinchon, Rakza, Karnoub, & Gobert, 2020;Zolotor, Runyan, Shanahan, et al, 2015), two were case-control studies (Bechtel et al, 2020;Keenan & Leventhal, 2010), and one was a cohort study (Fujiwara, Isumi, Sampei, Yamada, & Miyazaki, 2020b). Of the remaining nine; four (ChiCtr, 2019; JPRN-UMIN000038940, 2020; NCT04568538, 2020; NCT04608877, 2021) were trial registry records of ongoing RCTs, one RCT registry record (JPRN-UMIN000012445, n.d.) was for a completed RCT which had not yet published results, two published RCT protocols (Cook, Seymour, Giallo, et al, 2015;Obikane, Baba, Shinozaki, et al, 2021) had not published esults, and two studies did not report any of our outcomes of interest (Fig.…”

“…Ongoing and unpublished studies (all study designs) are presented in Appendix 4 Table S1. Nine studies were conducted in the USA (Barr et al, 2009b;Bechtel et al, 2020;Cala et al, 2020;Dias et al, 2017;Groisberg et al, 2020;Keenan & Leventhal, 2010;McRury & Zolotor, 2010;NCT04608877, 2021;Zolotor et al, 2015), six in Japan (JPRN-UMIN000012445, n.d.; Fujiwara et al, 2012;Fujiwara et al, 2020a;Fujiwara et al, 2020b;JPRN-UMIN000038940, 2020;Obikane et al, 2021), two in Canada (Barr et al, 2009a;Lou et al, 2011), two in Iran (Arshadi et al, n. d.;Bishe et al, 2020), two in Brazil (Lopes, 2017;, and one in France (Vinchon et al, 2020), Australia (Cook et al, 2015), Turkey (NCT04568538, 2020), and China (ChiCtr, 2019). The intervention was delivered in a hospital setting in eight studies (Arshadi et al, n.d.;Dias et al, 2017;Fujiwara et al, 2020a;Groisberg et al, 2020;Keenan & Leventhal, 2010;NCT04608877, 2021;Vinchon et al, 2020;Zolotor et al, 2015), at home in eight studies (Barr et al, 2009a;Barr et al, 2009b;Bishe et al, 2020;Cook et al, 2015;Fujiwara et al, 2012;Fujiwara et al, 2020b;McRury & Zolotor, 2010;Obikane et al, 2021), in hospital and/or at home in two studies (Cala et al, 2020;…”

Why admitted cases of AHT make a low quality reference standard: A survey of people accused of AHT in France

“…This is presented as evidence for the accuracy of the diagnoses in the diagnosed AHT case. Indeed, these “confession based studies” are often cited as providing the central evidence base for the SBS hypothesis [ 15 , 16 ].…”

Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data

“…Such studies uses cases diagnosed as AHT [ 5 ] as a reference standard, with those diagnoses based on findings already associated with AHT, in order to determine findings associated with AHT (see Fig. 1 A [ 6 ]). The results of such studies simply reflect the findings that were used in making the diagnosis, i.e., the findings widely believed to be associated with AHT.…”