The Unspoken Shaken Baby Lie Detector Algorithm—An Analysis of Diagnostic Procedures in Cases of Allegedly Abusive Head Trauma without External Signs of Trauma

Abstract

Various algorithms have been developed for diagnosis of Abusive Head Trauma (AHT); however, there is no explicit algorithm for the 1/3 of alleged AHT cases which present with findings restricted to subdural and retinal hemorrhages, with or without encephalopathy—i.e., isolated triad cases. Moreover, such cases have been lumped together with AHT cases with external sign of trauma and all diagnosed as AHT despite those we are focusing on lack signs of trauma. It is therefore relevant to analyze how this diagnosis can be reached in the absence of unequivocal trauma. Our analysis indicates that with respect to isolated triad cases, a two-step algorithm seems to be in use—but unspoken. The first step concerns a ruling out diagnostic process and the second step addresses the veracity of the caregivers’ narrative. Both steps are based on the traditional AHT mechanism theories and ten tacitly applied auxiliary hypotheses which are, however, questionable or incorrect. If the traditional AHT mechanism theories and necessary auxiliary hypotheses are not valid, then neither is the two-step algorithm. Accordingly, we propose that in alleged AHT cases with no external signs of trauma, the two-step algorithm—here referred to as the unspoken shaken baby lie detector algorithm—should be abandoned.

Denialism Preserves Scientific Controversies: a Case Study of Abusive Head Trauma Research

“…When embracing the traditional SBS/AHT theories, the infant will likely be removed from its caregivers; however, this may not always be in the child's best interests as not all cases assessed using traditional SBS/AHT theories may be true abuse cases. For example, if one were to embrace the hypoxicbrain-swelling-increased-intracranial-pressure-cascade-theory, an infant without external signs of trauma would probably not be classified as an SBS/AHT case (37). Although protecting infants is understandable among child-protection clinicians, the use of such a value-based judgment by the concerned scientists when classifying AHT cases in scientific studies will become a huge problem (39,40).…”

“…The reason why circular reasoning was and still is an issue is that the diagnosis of SBS/AHT in most studies was determined by a child protection team and based on the traditional SBS/AHT theories (16,37). These diagnoses were subsequently applied to classify true positive cases by researchers in observational studies on which the diagnostic accuracy studies were based (6).…”

“…These diagnoses were subsequently applied to classify true positive cases by researchers in observational studies on which the diagnostic accuracy studies were based (6). Since all triad cases without external signs of trauma were classified as true positive (TP) and accordingly none was classified as false positive (FP), the positive predictive value [TP/(TP+FP)] became 100% (37). Such studies will obviously present results that are too good to be true and would ostensibly corroborate any theory, including the traditional SBS/AHT theories (38).…”

Traumatic Head Injury and the Diagnosis of Abuse: A Cluster Analysis

“…They assert that the triad lacks sufficient research validation to support this diagnosis. [31][32][33] These critiques question the possibility of identifying a subpopulation of children with AHT within the larger population of children with neurologic injury, both in research and in clinical practice.…”