Questionnaire-Based Experimental Study of the Diagnostic Process in Suspected Shaken Baby Syndrome

Objective

The objective of this study was to examine the correctness of the statement that the diagnosis of shaken baby syndrome (SBS) is a “medical conclusion.”

Design

If the outcome of an event is considered bad, people tend to attribute intent or responsibility. Against this backdrop, a randomized, blinded trial was applied using two case-based questionnaires of possible violent shaking of an infant, identical except for the outcome: fatal or nonfatal.

Setting

We used a report of a 2-month-old baby who had suddenly stopped breathing and was subsequently shaken by the father with the intention to resuscitate him. After admission, encephalopathy, subdural hemorrhages, and retinal hemorrhages were detected.

Participants

A total of 1269 randomly selected physicians received the questionnaire, whose distribution was randomized and blinded. The participants were not informed about the existence of two versions of the questionnaire.

Results

The participants who responded to the fatal version considered in a significantly higher proportion (79% [95% CI: 73−85]) that shaking caused the triad findings than those who responded to the nonfatal version (68% [95% CI: 61−75]) (p = 0.01). When pediatricians and ophthalmologists are merged, the corresponding proportions were (91% [95% CI: 86−96]) versus (74% [95% CI: 66−82]) (p = 0.001). Radiologists and forensic pathologists did not distinguish significantly between fatal and nonfatal outcomes.

Conclusion

The study indicates that among pediatricians and ophthalmologists, the diagnostic process in suspected SBS is more value-based than evidence-based. As these two specialties dominate the SBS diagnostic procedure, the SBS diagnosis is, in this sense, not strictly a “medical conclusion.”