Re‐evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses
Authors: Johan Wikström
Aslak Syse
Knut Wester
Ulf Stridbeck
Journal: Acta Paediatrica (2021)
Discipline: CLINICAL MEDICINE
Keywords: abusive head trauma; benign external hydrocephalus; child abuse; shaken baby syndrome; subdural haematoma.
Affiliations: Department of Clinical Medicine K1 University of Bergen Bergen Norway, Department of Public and International Law Faculty of Law University of Oslo Oslo Norway, Department of Radiology Uppsala University Uppsala Sweden

Abstract:  Aim: The criteria for diagnosing abusive head trauma (AHT) are not well defined and this condition might be diagnosed on failing premises. Our aim was to review criminal AHT cases in Norwegian courts by scrutinising the underlying medical documentation. Methods: Cases were identified in the data registry for Norwegian courts from 2004 to 2015. Documentation was obtained from relevant health institutions. The medical co-authors first made independent evaluations of the documentation for each child, followed by a consensus evaluation. Results: A total of 17 children (11 boys) were identified, all diagnosed as AHT by court appointed experts, 15 were infants (mean age 2.6 months). A high proportion (41.2%) was born to immigrant parents and 31.3% were premature. The medical findings could be explained by alternative diagnoses in 16 of the 17 children; 8 boys (7 infants - mean age 2.9 months) had clinical and radiological characteristics compatible with external hydrocephalus complicated by chronic subdural haematoma. Six children (five infants with mean age 2.1 months) had a female preponderance and findings compatible with hypoxic ischaemic insults. Conclusion: The medical condition in most children had not necessarily been caused by shaking or direct impact, as was originally concluded by the court experts. 

Retracted: No

PubPeer comments:
 For international readers, it should be noted that this is a controverial paper that has gained massive attention in the media and is part of a longer debate. The first author of the paper published [a comment] on shaken baby syndrome in the Journal of the Norwegian Medical Association in 2018 calling for a revision of the diagnosis due to lack of evidence and the possibility of misdiagnosis. A [response] was given, signed by eighteen experts. Since then, the debate has been ongoing. The media has also played a part by telling stories of parents who claim to have been wrongfully convicted for child abuse. In May 2019, the Norwegian Society of Pediatricians published [a response to Wester] in Journal of the Norwegian Medical Association concluding that (my translation): We are worried that one-sided and oversimplified media coverage can have negative consequences for the safety and legal protection of children and lead to unfounded speculations that innocent parents have been convicted. We do not consider that continued polemics with Wester about this matter in any way will be of help for children nor their parents, and by this we want to end the discussion. The debate is important for this paper (in Acta Paediatrica) as well. In October 2020, the authors published [another paper] on the same cases that is reviewed in the present study. The publication gained [attention and critique] . Now, this paper (in Acta Paediatrica) has been published from a medical perspective. However, several physicians involved in the described cases have voiced concerns that multiple aspects of the cases have been neglected and that information is missing ([NRK, 2021-06-10] ). A letter of concern was sent by one of the physicians to the chief editor, who responded ([NRK, 2021-06-10] ): As chief editor I don t want to censor controversial articles as long as they don t contain fraudulent content? You are certainly welcome to submit an editorial which we can publish ASP after it has been accepted. Another physician involved in one of the cases, possibly case #2, states that ([NRK, 2021-06-10] , my translation) The real story is that the child was first admitted at six weeks of age after multiple concultations at the emergency room. At the hospital, one found fracture of the femur, and the police and Child Welfare Services were noticed The child was discharged after three weeks in hospital. Shortly after, the child was readmitted with several new injuries. This time one found eight recent rib fractures and nine rib fractures that were partially healed. I examined the child at this second admission. It had an oxygen tank. The chest collapsed competely during breathing due to the recent rib fractures, and one couldn t get any eye contact. The child was seriously harmed, but survived. Another quote from one of the critics is that ([NRK, 2021-06-10] , my translation) All physicians make errors. The central point here is that this paper does not present the actual circumstances nor the actual patterns of injury and harm seen in these cases. It is based on false premises. I am shocked that this is attempted camouflaged and published in this way. The first author of the paper rejects the critique and states that no important information has been omitted from the paper and that each case has been carefully reviewed. They have used five years to collect data, approvals, and to review the cases with a neuroradiologist. All medical records and all medical images were reviewed, and the diagnoses suggested in the paper are based on them. ,