The Swedish Agency for health technology-report about traumatic shaking: much ado about nothing?
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COMMENTARY
The Swedish Agency for health technology-report about traumatic shaking: much ado about nothing? Robert A. C. Bilo 1 Accepted: 12 July 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract The 2016 Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) systematic review deals with the role of the ‘triad’ (subdural hematoma, retinal hemorrhages, and various forms of brain symptoms) in the medical investigation of suspected traumatic shaking. In this commentary we will not discuss the methodological shortcomings of the SBU-review but will concentrate on the effects of the review on the daily practice of protecting children and families in court procedures. In our opinion the report did not add anything to what was already known in clinical and forensic medicine. The SBU-review confirmed that shaking can cause the ‘triad’ and that there are other explanations for the ‘triad’ and its components. The report however did not provide a realistic list of these other explanations. The review reduced the discussion about inflicted head injury in young children to a discussion about the ‘triad’ and traumatic shaking, ignoring the fact that ‘diagnosing’ inflicted head injury concerns a complete clinical and forensic evaluation of all individual and combined findings, of which for example the presence of bruising or fractures, were excluded by the SBU-panel. Keywords SBU-report . Inflicted head injury/abusive head trauma . Shaken baby syndrome . ‘Triad’ . Differential diagnosis
Introduction The 2016 Swedish Agency for Health Technology Assessment and Assessment of Social Services (Statens Beredning för medicinsk och social Utvärdering: SBU) report about ‘traumatic shaking’ [1] and the 2017 summarizing article in Acta Paediatrica [2] were heavily criticized, mostly because of concerns about methodological shortcomings [3–11]. In this commentary we will not discuss these shortcomings, but rather concentrate on the effects of the report on the daily practice of protecting children and families in court procedures. Offiah et al. [10] warned for potential negative effects of the report: ‘Given the likely significant impact of this report in child protection cases.…’. The SBU (and not the members of the SBU expert panel) replied to Offiah [12]: ‘The report has no legal status. It is a scientific health technology assessment. Therefore, it is not expected to have any direct legal impact.’
* Robert A. C. Bilo [email protected] 1
Department of Forensic Medicine, Section on Forensic Pediatrics, Netherlands Forensic Institute, PO Box 24044, 2490 AA The Hague, The Netherlands
Daily practice characterizes this statement as one made from the ivory tower of theoretical reasoning without any consideration of the practical impact. Professionals in child protection, (forensic) pediatrics and forensic (pediatric) pathology worldwide have experienced the (medicolegal) impact of the report and were confronted with confusion in court. Several of us have been asked in c
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