PerspectivesAre you interested in submitting a Perspective Article? Be sure to read The Science Advisory Board's Editorial Guides for Perspective Articles. Click here. Shaken Baby Syndrome: Putting Evidence Based Medicine to the Test? by Jan E. Leestma, MD, MM There are several very important scientific issues involved in Shaken Baby Syndrome not to mention the legal and societal consequences of them. The crux of the issue is that a large number of physicians (pediatricians mostly) subscribe to the theory that when a baby is shaken our of frustration or rage (without impacting any surface), that there is a pattern of pathology and clinical symptomology seen characteristic for this particular action and that if these features are observed they virtually assure that shaking has occurred and that the individual present at the time is guilty by child abuse. Furthermore, some have stated that shaking and shaking-impact are virtually the same and have the same significance. The problem with all of this is that the scientific evidence for many aspects of the "syndrome" have not been proven and in fact have largely been falsified by contrary data yet belief seems to hold sway over the methods and procedures of science. Specifically, biomechanical studies and independent calculations have shown that free shaking of a baby model cannot produce sufficient angular accelerations or G forces ( about 10 G ) that are apparently needed to produce subdural hematomas, brain injury and hemorrhage, retinal hemorrhages, axonal injury, etc. (100s of Gs). However, if impact occurs the threshold for subdural hematoma and brain injury is easily reached. The conclusion is that pre-impact movements probably have nothing to do with the pathology observed and ascribed to shaking. Other important facts are that retinal hemorrhages, clearly over-represented in abused babies, have not been conclusively shown to be due to shaking, nor are there apparently specific types of hemorrhages that provide clues to the mechanisms of injury that may be involved. The fact is that the mechanisms for retinal hemorrhages in infancy associated with trauma are not known and the case data that has been published to support shaking-retinal hemorrhage connections are statistically invalid due to case selection errors, and insufficient case controls and numbers. A further important issue in alleged shaking cases is that it is widely held that so-called "short" falls cannot produce fatal injury, subdural hematomas, skull fractures, brain injury and retinal hemorrhages in infants and that the mere presence of these findings in possible abuse cases makes them willfully inflicted injuries. Here again the case evidence and experimental biomechanics evidence shows that these assertions are not true, yet the beliefs continue. The consequences of these issues and other related to them, are that potentially innocent individuals are being charged and convicted (sometimes with potential for capital punishment) of child abuse on the basis of flawed science and beliefs rather than hard data. Cutting to the chase, in equivalent felony murder cases the burden of proof is much more robust and requires eye witnesses, video tapes, DNA evidence, fingerprint evidence, trace evidence, etc....none of which are present in most child abuse fatality cases. The evidence that is used to convict is based on medical expert opinion not backed up by scientifically verifiable and sustainable facts. The aura that surrounds most child abuse cases is one of extreme prejudice making it almost impossible, once someone is accused of shaking a baby, to obtain a fair an impartial trial based upon sound evidence. This unfortunate fact imperils one of our most important constitutional guarantees, that of a fair trial and with innocence presumed until proven otherwise. While there are many strong feelings that surround this issue and the controversies I have mentioned...the fact remains that if we subscribe to the notion that medicine and the physical and life sciences should be evidence (science) based...and expert opinion must therefore conform to the scientific method...yet many of our colleagues can't or won't face the problem of veracity of the basis of their opinions and continue to testify in court and swear to tell the truth...we have a serious problem that goes to the core of our disciplines and to the core of our societal values. These issues need to be critically examined, debated if need be, and fixed by collecting proper data, performing proper experiments, make well controlled case studies to resolve the scientific issues involved. Until and unless this is done, we must recognize the limits of our knowledge for the sake of our self respect and our civil rights. ### Jan E Leestma, MD, MM The Chicago Institute of Neurosurgery and Neuroresearch Science Advisory Board member since February 2002 ### << Previous Next >> [ View All Perspectives ] |
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