In order to ensure that evidence is unbiased it is sometimes necessary to retreat to the scientific ivory tower
Dr. Bilo maintains that the Swedish SBU report does not add anything new that might help him within forensic pediatrics . This claim is, however, based on his personal interpretation of the SBU report and the research question addressed, namely: With what certainty can it be claimed that the triad, subdural hematoma, retinal hemorrhages and encephalopathy is attributable to isolated traumatic shaking ? The research question is certainly not identical to Dr. Bilo’s second question: “Is the triad, if present in a child, always caused by, or proof of shaking?” The word “always” makes the answer almost self-evident.
Neither SBU nor the expert panel is responsible for how the content and the conclusions of the report are (mis-)understood or (mis-)interpreted. The report represents a strictly scientific analysis, and SBU is not involved in the application of potential clinical or societal consequences of the systematic review. Concerned authorities, clinicians, societal agencies, and law enforcement are expected to take independent, appropriate action.
Dr. Bilo maintains that in real life infants with SDH, RH and encephalopathy usually also have external signs of trauma such as bruises and fractures . According to Dr. Bilo, the fact that SBU focused on studies which included cases of the triad in the absence of external signs of injury, makes the SBU report futile. A compilation of scientific studies shows, however, that of all cases of abusive head trauma (AHT), the triad was present without external injuries, in on average 1/3 (min 20%, max 45%) .
Further, Dr. Bilo criticizes SBU for retreating to an ivory tower, isolated from real life issues about child abuse . Quite correct - SBU and the expert panel deliberately retreated to the scientific ivory tower, followed standard procedures of health technology assessment, and neither ideological interests nor personal values were to be discussed. Particularly with respect to emotionally influenced issues like previous SBS studies it is of utmost importance to separate values from scientific evidence. After two years of work in the ivory tower, the expert panel emerged and has ever since participated actively in the discussion of the consequences of the values at stake.
In conclusion, it is sometimes necessary to enter the scientific ivory tower and ignore any preconceived ideas. Probably, retreating to the scientific ivory tower might be particularly helpful for pediatricians who are finding it difficult to distinguish between their roles as clinicians and as scientists.
Compliance with ethical standards
The present paper is in compliance with the Journals ethical standards.
Conflict of interest
The authors declare to have no conflict of interest.
According to Swedish legislation this kind of paper needs no ethical approval.
Neither patients nor research participants were involved.
- 1.Bilo RAC. The Swedish Agency for health technology-report about traumatic shaking: much ado about nothing? Forensic Sci Med Pathol. 2018. https://doi.org/10.1007/s12024-018-0006-7.
- 3.Lynøe N, Eriksson A. Is focusing on the triad in suspected child abuse cases really irrelevant and of no practical use? Acta Paediatr. 2018. https://doi.org/10.1111/apa.14442.