Easier to see the speck in your critical peers’ eyes than the log in your own? Response to Debelle<i>et al</i>

Lynøe, Niels; Elinder, Göran; Hallberg, Boubou; Rosén, Måns; Sundgren, Pia C.; Eriksson, Anders

doi:10.1136/archdischild-2018-315380

Cited by 4 publications

(6 citation statements)

References 3 publications

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“…This review has been subjected to much criticism with responses from the expert group and others [18][19][20][21][22][23]. To our understanding the conclusions from the SBU systematic review are solid, while the need of more research was highlighted.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Many physicians regard the combination of encephalopathy, subdural haemorrhage (SDH), retinal haemorrhage (RH), rib fractures, and classical metaphyseal lesions (CML) as highly specific for abusive head trauma (AHT). However, without observed abuse or other criteria that are independent of these findings, bias risk is high. Methods Infants subjected for examination under the suspicion of maltreatment during the period 1997-2014 were identified in the National Patient Registry, International Classification of Diseases (ICD-10 SE). The medical records were scrutinized for identification of cases of witnessed or admitted physical abuse by shaking. The main outcome measures were occurrence of SDH, RH, fractures and skin lesions. Results All identified 36 infants had been shaken, and for 6, there was information indicating blunt force impact immediately after shaking. In 30 cases, there were no findings of SDH or RH, rib fractures, or CMLs. Six infants had finding(s) suggestive of physical abuse, two with possible acute intracranial pathology. One infant with combined shaking and impact trauma had hyperdense SDH, hyperdense subarachnoid haemorrhage, suspected cortical vein thrombosis, RH, and bruises. Another infant abused by shaking had solely an acute subarachnoid haemorrhage. Both had pre-existing vulnerability. The first was born preterm and had non-specific frontal subcortical changes. The other had bilateral chronic SDH/hygroma.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…The techno-science for diagnosing infant abuse such as SBS/AHT, purportedly for the sake of the infant, has inherent fallacies [8]. This is even more pronounced as the triad of SBS/AHT is shown to have insufficient evidence to be caused by shaking [13], although these findings have been challenged by vivid criticism its conclusions has not been changed and are considered to be valid [14,[33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Parents’ experiences of seeking health care and encountering allegations of shaken baby syndrome: A qualitative study

et al. 2020

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Objectives To explore parents' experiences of seeking health care for their children and instead being accused by healthcare professionals of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT), being reported to Social Services, undergoing judiciary processing, and the impact of these events on family (dis)integration. Methods Design: A qualitative study based on qualitative content analysis. Participants: Twelve parents in Sweden, mothers and fathers, seeking health care for their infants, encountering allegations of SBS/AHT, losing custody of their infants, and being subjected to a judiciary process, and finally regaining custody of their children. Data collection: In-depth interviews. Results An overarching theme 'Fighting for protection of their child after being trapped by doctors' and four sub-themes were developed to reflect the parents' experiences, reactions and interpretations. The first sub-theme, 'Being accused of injuring the child', illuminated the shock experienced when seeking care and instead being accused of being a perpetrator. The second, 'Chaos and powerlessness', refers to the emotions experienced when losing custody of the child and being caught in the enforcement of legislation by the authorities. The third,´The unified fight against the doctors' verdict´, illustrates the parents' fight for innocence, their worry for the lost child, and their support and resistance. The fourth, 'The wounded posttraumatic growth', describes the emotions, grief, panic, anxiety, and challenges in reuniting the family, but also the parents' reflections on personal growth. Unanimously, they had experienced the authorities' inability to reconsider, and expressed a deep mistrust of paediatric care.

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“…Moreover, there is insufficient evidence on which to assess the diagnostic accuracy of the triad in identifying SBS/AHT, irrespective of presumed injury mechanisms . This systematic literature review has been criticized, commented on, and answered by the SBU expert group . We have provided evidence of perinatal risk factor profiles of infants with abuse diagnosis and SDH, rib, or long bone fractures, risk profiles that are similar to those having a medical cause of SDH or fractures.…”

Section: Introductionmentioning

confidence: 99%

“…22 This systematic literature review has been criticized, commented on, and answered by the SBU expert group. [23][24][25][26][27][28][29] We have provided evidence of perinatal risk factor profiles of infants with abuse diagnosis and SDH, 30 rib, or long bone fractures, 31 risk profiles that are similar to those having a medical cause of SDH or fractures.…”

Section: Introductionmentioning

confidence: 99%

Medical diagnoses among infants at entry in out‐of‐home care: A Swedish population‐register study

Högberg

Sennerstam

Wester

et al. 2019

Health Science Reports

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Background and aims Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out‐of‐home care. The objective of this study was to analyse infants placed in out‐of‐home care in Sweden by incidence, medical diagnoses, and perinatal factors. Methods This was a population‐based register study of infants born in Sweden 1997 to 2014. Data were retrieved from registers at the Swedish National Board of Health and Welfare and Statistics Sweden. Outcome measures were out‐of‐home care categories: (a) “Problems Related to Social Environment/Upbringing”, (b) “Abuse diagnoses without SDH (subdural haemorrhage), RH (retinal haemorrhage), rib fracture, or long bone fracture”, and (c) “SDH, RH, rib fracture, or long bone fracture.” As a reference population, we randomly selected infants without medical diagnoses born the same year. Results Overall incidence of out‐of‐home care was 402 per 100 000. For subcategories (a), (b), and (c), the incidences were 14.8 (n = 273), 3.77 (n = 70), and 9.83 (n = 182) per 100 000, respectively. During the study period, the first remained unchanged; the latter two have been increasing. Compared with other reasons for out‐of‐home care, children in category (c), “SDH, RH, rib fracture, or long bone fracture”, had increased odds of being boys (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI], 1.08‐2.38) and decreased odds of having a mother being single (aOR 0.49; 95% CI, 0.32‐0.75) and a smoker (aOR 0.60; 95% CI, 0.37‐0.96). Compared with the reference population, children in this category were more often twin born (7.7% versus 2.8%), preterm (18.5% versus 5.5%), and small‐for‐gestational age (5.2% versus 2.1%). Conclusion SDH, RH, rib fracture, or long bone fracture constitute a minor part of medical diagnoses for infants entered in out‐of‐home care, but have been increasing, both in numbers and proportion. Overdiagnosis of abuse might be a possible reason but cannot be ascertained by this study design.

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Easier to see the speck in your critical peers’ eyes than the log in your own? Response to Debelleet al

Cited by 4 publications

References 3 publications

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

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

Parents’ experiences of seeking health care and encountering allegations of shaken baby syndrome: A qualitative study

Medical diagnoses among infants at entry in out‐of‐home care: A Swedish population‐register study

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