Swedish Physicians’ Reasoning about Suspected Shaken Baby Syndrome—A Qualitative Study

Abstract

Background: The diagnostic procedure in suspected shaken baby syndrome (SBS) is the subject of a scientific controversy. Traditionally, isolated “triad findings” [encephalopathy symptoms, subdural hemorrhage, and retinal hemorrhages without signs of trauma] are considered highly specific of shaking. Recent theories suggest that trauma is not necessary to explain the findings, and a systematic review revealed that there was insufficient scientific evidence to predict violent shaking.

Aims: To explore how involved Swedish physicians reason about the diagnostic procedure.

Methods: 400 pediatricians, 400 ophthalmologists, and 400 radiologists were randomly selected– together with all forensic pathologists in Sweden (n=69) – to participate in a questionnaire-based study. Qualitative content analysis was applied to the 595 free text comments.

Results: Three main themes and 8 categories were identified: I) Causality issues, with the categories a) Robustness of the diagnostic accuracy, b) Paradoxical phenomena; II) Diagnostic procedures, with the categories a) Reasons for judgement, b) Emotional impact; III) Physician’s professional role, with the categories a) Assessing trustworthiness, b) Assessing learning and training, c) Duties and ethical dilemmas and d) Legal consequences.

Conclusions: To optimize the diagnostic procedure, we suggest improvement of the diagnostic process by raising research quality and taking the guardian’s narrative into greater consideration.