Title: The new Swedish report on Shaken Baby Syndrome is misleading
Abstract: Acta PaediatricaVolume 106, Issue 7 p. 1040-1040 Short CommentaryFree Access The new Swedish report on Shaken Baby Syndrome is misleading Kerstin Hellgren, Kerstin Hellgren Astrid Lindgren Children′s Hospital, Karolinska University Hospital, Stockholm, Sweden Karolinska Institutet, Stockholm, SwedenSearch for more papers by this authorAnn Hellström, Ann Hellström The Queen Silvia Children′s Hospital, Gothenburg, Sweden Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenSearch for more papers by this authorAnna-Lena Hård, Anna-Lena Hård The Queen Silvia Children′s Hospital, Gothenburg, Sweden Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenSearch for more papers by this authorLena Jacobson, Corresponding Author Lena Jacobson [email protected] Karolinska Institutet, Stockholm, Sweden Correspondence Lena Jacobson, Karolinska Institutet, MBC, St Erik Eye Hospital, Polhemsgatan 50, SE 11282, Stockholm, Sweden. Tel: +4686723665 | Email: [email protected] for more papers by this authorUlrika Lidén, Ulrika Lidén Astrid Lindgren Children′s Hospital, Karolinska University Hospital, Stockholm, Sweden Eye Department Södermanland, Eskilstuna, SwedenSearch for more papers by this authorStefan Löfgren, Stefan Löfgren Karolinska Institutet, Stockholm, Sweden St Erik Eye Hospital, Stockholm, SwedenSearch for more papers by this authorKristina Teär Fahnehjelm, Kristina Teär Fahnehjelm Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden St Erik Eye Hospital, Stockholm, SwedenSearch for more papers by this authorJan Ygge, Jan Ygge Karolinska Institutet, Stockholm, Sweden St Erik Eye Hospital, Stockholm, SwedenSearch for more papers by this author Kerstin Hellgren, Kerstin Hellgren Astrid Lindgren Children′s Hospital, Karolinska University Hospital, Stockholm, Sweden Karolinska Institutet, Stockholm, SwedenSearch for more papers by this authorAnn Hellström, Ann Hellström The Queen Silvia Children′s Hospital, Gothenburg, Sweden Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenSearch for more papers by this authorAnna-Lena Hård, Anna-Lena Hård The Queen Silvia Children′s Hospital, Gothenburg, Sweden Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenSearch for more papers by this authorLena Jacobson, Corresponding Author Lena Jacobson [email protected] Karolinska Institutet, Stockholm, Sweden Correspondence Lena Jacobson, Karolinska Institutet, MBC, St Erik Eye Hospital, Polhemsgatan 50, SE 11282, Stockholm, Sweden. Tel: +4686723665 | Email: [email protected] for more papers by this authorUlrika Lidén, Ulrika Lidén Astrid Lindgren Children′s Hospital, Karolinska University Hospital, Stockholm, Sweden Eye Department Södermanland, Eskilstuna, SwedenSearch for more papers by this authorStefan Löfgren, Stefan Löfgren Karolinska Institutet, Stockholm, Sweden St Erik Eye Hospital, Stockholm, SwedenSearch for more papers by this authorKristina Teär Fahnehjelm, Kristina Teär Fahnehjelm Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden St Erik Eye Hospital, Stockholm, SwedenSearch for more papers by this authorJan Ygge, Jan Ygge Karolinska Institutet, Stockholm, Sweden St Erik Eye Hospital, Stockholm, SwedenSearch for more papers by this author First published: 27 March 2017 https://doi.org/10.1111/apa.13845Citations: 12AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat 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 summarised in a paper by Lynøe et al. 3. He also provides necessary input on the importance of the morphology and distribution of retinal haemorrhages 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. In a recently published report, SBU evaluated the hypothesis that a triad of subdural haematoma, retinal haemorrhages and encephalopathy is always caused by traumatic shaking and concluded that there is insufficient evidence to support such hypothesis 2, 3. For paediatricians, paediatric ophthalmologists and radiologists caring for infants who are admitted to hospital with seizures, coma or other serious symptoms and are found to have subdural haematoma and retinal haemorrhages, it is well known that these signs may have various aetiologies of which one is shaking. Possible abuse must be considered if the history taking, laboratory results and radiological investigations fail to identify alternative causes. The SBU report concludes that there is only limited evidence that shaking of an infant can cause the triad signs, in contrast with the numerous reports describing such lesions in victims of verified shaking. It is unfortunate that the SBU panel neither included a paediatrician nor a paediatric ophthalmologist with experience of child abuse to facilitate a correct interpretation of the cited papers. The SBU report recommends ambitious research programmes which will take many years to perform and which will never reveal the true probability that an infant with certain signs and symptoms has been shaken given the difficulties in proving that shaking has occurred. The report offers no recommendations on how to handle infants with the above-mentioned signs. It is already evident to those caring for these infants that not all cases with the triad signs have been shaken. So what are the implications of this report for our patients, their parents and caregivers? If it is considered questionable that shaking may cause brain and eye haemorrhages, should we then refrain from reporting such cases to social authorities? Is it the opinion of SBU that no investigations of possible child abuse should be performed in cases with these signs, when medical work-up has failed to find an alternative plausible aetiology? The authors of the SBU report are concerned about the risk of overdiagnosing shaken baby syndrome, due to a presumed biased view among the medical professions that the triad signs always result from shaking. We do not share this concern, and we do not acknowledge that such a bias exists. The alternative aetiologies for the triad signs are well known to experienced paediatricians and paediatric ophthalmologists. Professor Alex Levin is right to be concerned about this report 2. In addition, he provides necessary input on the importance of morphology and distribution of retinal haemorrhages in the differential diagnoses between different causes of retinal bleedings. To miss a diagnosis of child abuse can result in continued trauma and even death. References 1Levin AV. The SBU report: a different view. Acta Paediatr 2017; 106: 1037– 9. 2 Skakvåld – Triadens roll vid medicinsk utredning av misstänkt skakvåld. SBU Rapport 255/2016. (In Swedish). Traumatic shaking – a systematic review. The role of the triad in medical investigations of suspected traumatic shaking. Swedish Agency for Health Technology Assessment and Assessment of Social Services. Report 255/2016. 3Lynøe N, Elinder G, Hallberg B, Rosén M, Sundgren P, Eriksson A. Insufficient evidence for 'shaken baby syndrome' – a systematic review Acta Paediatr 2017; 106: 1021– 7. Citing Literature Volume106, Issue7July 2017Pages 1040-1040 This article also appears in:Abusive Head Trauma and Shaken Baby Syndrome ReferencesRelatedInformation