Talk:Abusive head trauma

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Ongoing developments[edit]

In Sweden, now that one victim of sbs (a father) has been declared innocent on appeal to the Swedish Supreme Court on the basis of a baby's blood sample after serving a four-year prison sentence for sbs (the mimic of sbs was congenital rickets but no vitamin D blood test performed at birth) a group of medical practioners had the brilliant idea of using the obligatory dried blood sample that is taken from every new-born to test for vitamin-D levels.

The Swedish Council on Health Technology Assessment together with The Swedish National Council on Medical Ethics have initiated a two-year project that is ongoing and should be completed in March, 2016 on an assessment of sbs as a diagnosis. “We thought we were helping by uncovering these other medical conditions that can look like abuse, but are not abuse," Patrick Barnes, chief of pediatric neuroradiology at the Children's Hospital at Stanford University said, "It actually threatens the entire shaken baby syndrome working group and industrial complex.” RPSM (talk) 01:50, 4 May 2015 (UTC)

Eye on the Courts: Shaken Baby Syndrome Has Troubling Scientific Foundations - material from 2014[edit]

Eye on the Courts: Shaken Baby Syndrome Has Troubling Scientific Foundations RPSM (talk) 17:29, 28 October 2015 (UTC)

Learned article covers the main themes in questioning the diagnosis shaken baby syndrome[edit]

Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome. Steven C. Gabaeff, MD The author discloses he is a designated expert by the Los Angeles County Committee of Superior Court Judges “appointed to maintain a Panel of Expert Witnesses”, “providing expertise for both prosecutors and defense attorneys” in the areas of emergency medicine, child abuse and sexual assault. The author has provided expert opinions on medical-legal issues in criminal, civil and dependency matters for over 22 years in more than 1,300 consultations. RPSM (talk) 10:00, 4 February 2016 (UTC)

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Controversy in Sweden[edit]

It has been noted in many places that the diagnosis of SBS is crumbling. The recent report from the Swedish Council on Technology and Social Evaluation and the National Medical Ethics on "skakvåld" (SBS) appears to solidify this argument, noting that there is no scientific support for the SBS diagnosis based upon the constellation of findings which this article lists as forming the diagnosis, and indeed, little support demonstrating that the constellation is even a result of shaking. This article used to have a "Controversy" section, and as has been noted here before, I think it needs to be part of the article. From my perspective, I'm not sure there has been a true consensus on this issue in the last several years, but if there was, surely it must be eroding. Indeed, I'm not even certain that Sweden has a controversy at this point. They seem to have invalidated the diagnosis altogether.

The summary from Sweden's National Medical Ethics were that (my translation may not be completely accurate):

  • There is insufficient scientific evidence to assess the diagnostic accuracy of the triad to identify SBS.
  • There is limited scientific evidence that the triad (subdural bleeding, retinal hemorrhage, and various forms of brain dysfunction) and thus its components may occur from shaking.
  •  The triad or components of it can be caused by many things other than shaking.

I think that much of the "Legal Issues" section should be moved into a "Controversy" section, but I would like to hear some feedback. I don't want to put the time into it, only to have it removed.UncleHoot (talk) 18:37, 8 November 2016 (UTC)UncleHoot (talk)UncleHoot (talk) 18:37, 8 November 2016 (UTC) 13:32, 28 October 2016 (UTC)

The diagnosis is not crumbling. That is just goofy. The concept of the "Triad" is set up as a straw man by a few skeptics. No practicing clinical would refer to the "Triad" or would use that faulty framework to practice medicine or diagnose a child. It is clear that the "Triad" as framed by Tuerkheimer is not how any physician behaves, but people use it for their political advantage. As the SBU report is still only in Swedish, only those who have read Swedish will know what is says. Most would agree with the report that there is no diagnostic value to the "Triad" (which is what the report says). They only looked at "Triad" only criteria (no other injuries or signs of impact).
Shaking is dangerous to an infant. Even those who are skeptical all agree (Squier, Moran, Teas, Uscinski, Barnes, Findley....) This issue of the "Triad" is silly.
Within the wiki piece on AHT, there is a section referring to how "The findings of SBS are often referred to as a "triad". Clearly whoever put that in and then cited [25] did not read [25]. It says specifically "The complex features of AHT are often disparagingly distilling simply to “The Triad”; a term devoid of any real clinical meaning and not used at all in practice." I agree with that citation.Csgreeley (talk) 00:34, 1 November 2016 (UTC)
While awaiting the English translation of the report from Sweden, I have been poring over the Google translation and reading various news articles surrounding the findings. While some areas become nonsensical due to the bad translation, the conclusion seems to be that the diagnosis of SBS, which is largely based on the triad / constellation / RH + SDH / whatever-you-prefer-to-call-it, has little scientific foundation.
Whether it's called a "triad," a "constellation," or "diffuse bilateral subdural and subarachnoid hemorrhage with multi-layered confluent retinal and optic nerve sheath hemorrhage in conjunction with cerebral edema" it's still the (two or) three findings that form the basis of the diagnosis. I don't believe anyone would suggest that SBS / AHT is no longer diagnosed based on those findings. These are the findings from which physicians infer child abuse caused by violent shaking (skakvåld). It's much easier to call it a triad, for purposes of brevity, if nothing else, so I'm not sure that I understand your argument. If the diagnosis is made in some other way, as you keep alluding, then perhaps you can provide a better explanation. The citation you provided references an article that you wrote (presumably), so your support for it really doesn't add much to the discussion here, but it is noteworthy. It seems that the use of the term "triad" grew into disfavor, but it still pervades much of the literature, especially in the legal system, which, perhaps, is why Sweden chose that particular nomenclature.
The report also mentions the problem of circular reasoning, which I believe should be part of the "Controversy" section as well, given its inclusion in other medical and legal papers. It seems to be one of the main features behind the criticisms of the diagnosis.
Regardless, I agree that we should wait for the English translation of the report to avoid potential inconsistencies due to poor translation. I also expect the AAP and perhaps other groups to release statements / letters that run contrary to these findings, which can also be cited at that time. UncleHoot (talk) 18:37, 8 November 2016 (UTC)

Link to Swedish report (in Swedish and English)[edit]

http://www.sbu.se/contentassets/09cc34e7666340a59137ba55d6c55bc9/skakvald_2016.pdf

RPSM (talk) 17:51, 14 December 2016 (UTC)

According to Swedish Radio, an English version of the report exists but has not yet been published as three refusals have been recieved from scientific publications so far.

An excerpt from the report is below:

Sökningen gav 3 773 abstrakt varav 1 065 beställdes i fulltext. Av dessa exkluderades 1 035 då de inte uppfyllde inklusionskriterierna. Efter kvalitetsgranskning återstod 30 artiklar varav två av medelhög kvalitet men ingen studie av hög kvalitet. Det främsta skälet till att så få studier uppfyllde kvalitetskraven var att det saknades dokumentation om fallen var erkända eller bevittnade fall av skakvåld. Resultaten baseras således på endast två studier med erkänt skakvåld. Någon sammanvägning av resultaten i en metaanalys har därför inte varit möjlig. Projektgruppen har haft en diskussion kring samstämmigheten i de inkluderade studierna.

Chapter Four

The survey turned up 3 773 abstracts of which 1 065 with full text were obtained. Of these 1 035 were excluded as they did not fulfil the critera for inclusion. After being assessed for quality, thirty articles remained of which two (2) were of medium quality but no (0) articles were of high quality. The primary reason that so few of the studies fulfilled the quality critera was that documentation was lacking of actual cases where a confession or eye witnesses were involved. An assessment of the result in a meta-analysis was therefore not possible. A discussion about the consistency of the studies that were included arose within the project group.

RPSM (talk) 15:23, 2 January 2017 (UTC)

Appendix to Swedish report giving references to all the papers that were studied and reasons for exclusion:

http://www.sbu.se/contentassets/ce67f4884a3f464880274257259992fb/bilaga-6-studier-av-lag-kvalitet-och-exkluderade-studier.pdf

RPSM (talk) 12:25, 9 January 2017 (UTC)

English version of SBU Report: http://www.sbu.se/en/publications/sbu-assesses/traumatic-shaking--the-role-of-the-triad-in-medical-investigations-of-suspected-traumatic-shaking/ UncleHoot (talk) 13:27, 15 February 2017 (UTC)

Link to article[edit]

http://www.ga-innocenceproject.org/images/SBS%20Seminar-10.12.11/Plunkett%20Supplemental%20Materials/Plunkett%20Zip%20File/Uscinski%20R.%20SBS.%20Br%20J%20Neurosurg%202002.pdf RPSM (talk) 09:31, 29 December 2016 (UTC)

Article on Swedish report[edit]

Andy Coghlan Evidence of shaken baby questioned by controversial study New Scientist RPSM (talk) 16:40, 2 January 2017 (UTC)

Moran/Findley/Barnes/Squier 20012 sbs, AHT, and Actual Innocence. Getting it right.[edit]

http://repository.law.umich.edu/cgi/viewcontent.cgi?article=1559&context=articles RPSM (talk) 16:58, 2 January 2017 (UTC)

http://www.sciencedirect.com/science/article/pii/S1344622315300523

Waney Squier[edit]

I have expanded the content on Waney Squier to include details of her reinstatement following appeal. However, this section could do with further editing and expansion, which I don't have time to do. SmilingFace (talk) 13:50, 4 November 2016 (UTC)

I have to wonder if that content is still relevant, given that she was subsequently reinstated. I'm not sure what it adds to the article as a whole. UncleHoot (talk) 18:41, 8 November 2016 (UTC)
While reinstated for her license, she was not absolved of malfeasance.
Mitting said that the tribunal was justified in some cases in deciding that she had misrepresented the findings of the court, was deliberately misleading, acted outside her area of expertise, and failed to be objective and unbiased. But he ruled that many of the findings against her were unjustified, and he said that tribunals needed more understanding of the difficulties of being an expert witness in an adversarial court system where proceedings were controlled by judges and lawyers.
A GMC spokesperson said, “Mr Justice Mitting has confirmed that this case was not about scientific debate and the rights and wrongs of the scientific evidence but the manner in which Dr Squier gave evidence. The ruling makes clear that she acted irresponsibly in her role as an expert witness on several occasions, acted beyond her expertise and lacked objectivity, and sought to cherrypick research which it was clear did not support her opinions.” Csgreeley (talk) 00:56, 13 November 2016 (UTC)
The point is, this is not an article about Dr. Squier, and I cannot see a reason to make a "Waney Squier" section in the article. It held relevance when the court had found her guilty of "lying" among other charges. As you note, this is now simply about the way she testified in court. It is not about AHT or the diagnosis of AHT, nor does it have any legal impact on the diagnosis and the way it is handled in courts, except for the obvious chilling effect among defense witnesses, which, perhaps, is relevant.UncleHoot (talk) 16:56, 17 November 2016 (UTC)

This was a letter to the editor of DN - main broadsheet in Sweden[edit]

An initiative by two Swedish physicians representing a group of doctors, lawyers engineers, etc who contributed their time voluntarily and could not help noticing some inconsistencies in the cases which had been diagnosed with shaken baby syndrome causing their group to grow with new victims affected by this diagnosis.

They decided to apply to Statens beredning för medicinsk och social utvärdering, (The Swedish Agency for Health Technology Assessment and Assessment of Social Services) to conduct an impartial assessment of the diagnosis.

http://www.dn.se/debatt/rattslaget-osakert-for-spadbarnsforaldrar/ RPSM (talk) 15:59, 3 January 2017 (UTC)

Comment from Utah Law review article[edit]

Some may argue that we need not worry about judicial inexperience with science because it is just this inexperience that will steer a Justice toward reputable journals and away from dubious junk science. But this logic is not completely reassuring. . . . Justices cite authorities with a terrific range of prestige and reputation. Yes, they rely on articles in the New England Journal of Medicine, but they also cite to blog posts, sporting magazines, interest group websites, and (in lower courts) even to Wikipedia. RPSM (talk) 16:54, 27 January 2017 (UTC)

Paper which deals with lay (non-medical) and non-"mainstream" views: Article reference: http://epubs.utah.edu/index.php/ulr/article/viewFile/1195/871 RPSM (talk) 11:53, 30 January 2017 (UTC)

Paper which includes links to both sides of the controversy RPSM (talk) 12:22, 30 January 2017 (UTC)

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Paper describing the Swedish official review of shaken baby syndrome[edit]

(Swedish Agency for Health Technology Assment and Assessment of Social Services) http://onlinelibrary.wiley.com/doi/10.1111/apa.13760/pdf RPSM (talk) 15:06, 16 June 2017 (UTC)

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Link to 2010 paper[edit]

[Published online 2010 Sep 29.Unexplained Fractures: Child Abuse or Bone Disease? A Systematic Review RPSM (talk) 08:20, 7 August 2017 (UTC)

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