Umeå universitets logga

During the 1980′s a sudden life-lessness attack in a very young infant was described as “near-SIDS”, and a caregiver who observed and tried to revive the infant was considered to be reliable and honourable. If, after the later acceptance of the traditional shaken baby theory, bilateral thin subdural hemorrhages (SDH) and retinal hemorrhages (RH) are detected after a lifelessness attack such a reliable caregiver has by default been transformed into an unreliable perpetrator of violent shaking. In 2016, the term “near-SIDS” was – via “apparent life-threatening event” (ALTE) − replaced by “brief resolved unexplained event” (BRUE). We suggest that such a life-threatening event is not always brief, and not always resolved. Based on a neglected hypoxia theory from 2004 we suggest as a hypothesis that a prolonged episode of apnea can result in brain hypoxia, brain edema, SDH, RH and increased intracranial pressure. The new hypothesis includes two new concepts: Prolonged Non-fatal Unexplained Event (PNUE) and Prolonged Fatal Unexplained Event (PFUE) which together with the hypoxia theory might explain why these two separate diagnoses have been conflated into one, viz. shaken baby syndrome (SBS). We suggest a study design that might corroborate or falsify the hypothesis, and if our hypothesis is corroborated, current “unreliable perpetrators” could be re-established as reliable resuscitators.

Myocarditis is an inflammatory disease of the myocardium with either focal or diffuse involvement and usually gives rise to chest pain, dyspnea, palpitations, and fatigue. In severe cases, arrythmias, syncope, and cardiogenic shock may occur. Acute myocarditis is most commonly caused by a variety of viruses with cardiotropic properties. Rare causes of myocarditis include bacterial infections. We, herein, describe a case of acute myocarditis caused by the intracellular bacterium Francisella tularensis. A young and previously healthy male in Northern Sweden was referred to the emergency department due to intense upper-chest pain and dyspnea. ECG exhibited minimal ST-segment elevations and laboratory parameters revealed pathological levels of high-sensitivity cardiac troponin and C-reactive protein. Radiological imaging showed increased metabolism in enlarged lymph nodes in the chest and signs that could be compatible with increased metabolism in the left ventricular of the heart. The combination of acute myocarditis and enlarged lymph nodes was believed to be caused by the intracellular bacterium Francisella tularensis, endemic in the Northern Sweden, and was verified with positive serology. The patient showed full recovery after antimicrobial treatment. As this is the fifth published case of myocarditis associated with Francisella tularensis, we suggest considering tularemia in acute myocarditis in tularemia-endemic area.

The process used to diagnose Shaken Baby Syndrome (SBS), a subgroup of Abusive Head Trauma (AHT) without signs of relevant trauma, is not reliable and remains uncertain. There is insufficient scientific evidence for any doctor or medical expert to conclude that if a child has three medical findings, the “triad”, then the infant must have been shaken or abused. All studies showing a ‘strong’ association between the triad and the diagnostic accuracy of the SBS diagnosis rely on circular reasoning., There is insufficient scientific evidence that the isolated triad can predict traumatic shaking, as there is a high risk of bias. There is an ongoing scientific controversy within the area. The aim of the present article is to facilitate a better understanding of this scientific controversy for those who are not themselves medical scientists -, such as lawyers, prosecutors, and judges. The legal and medical consequences of the current scientific controversy is that an incorrect diagnosis may delay the correct diagnosis, harm the infant and its family, and jeopardis e rule of law.

A key element for diagnosing cardiac enlargement in an autopsy setting is relevant heart weight references. However, most available references are to a large extent not representative of a medicolegal autopsy population, implying that reference weights are likely lower than those in the relevant population.To establish more applicable heart weight references in a medicolegal autopsy population, we designed a heart weight model that accounts for undiagnosed cardiac enlargement using data from 11,897 nontraumatic Swedish medicolegal autopsy cases autopsied between 2010 and 2019. The model was validated in 296 nonobese young adult suicidal hanging cases.For a decedent of average height (174 cm), the evidence that a heart weight was enlarged reached weak support at approximately 430 g, substantial support at approximately 480 g, and strong support at 520 g. The modeled prevalence of cardiac enlargement was very high among elderly and obese decedents.We believe that our model is more applicable in a medicolegal setting than those previously published. The presented quantification of the degree of uncertainty regarding diagnosis can help the pathologist in diagnosing cardiac enlargement. To facilitate the use of this model, we also made it available through a simple online tool (https://formedum.shinyapps.io/HeartWeightCalc/).

Fatal intoxications with opioids are known to be associated with an increased lung weight, as well as with brain and pulmonary edema and urinary retention. However, there is evidence to suggest that fatal intoxications with non-opioid substances are also associated with increased lung weight; however, the latter aspect has not been comprehensively analyzed. To determine to what extent opioid and non-opioid substances are associated with increased lung and brain weight, we studied these organs in cases where the cause of death was attributed to intoxication with a single agent. Using data from cases autopsied at the National Board of Forensic Medicine (NBFM) in Sweden from 2009 through 2019 where the cause of death was attributed to a single substance, we created models of combined lung weight and brain weight. The models used age and sex as predictors as well as nested varying effects for the specific intoxicant and category of intoxicant. Suicidal hanging with negative toxicology cases served as controls. The population majority was male among both intoxications (68%) and controls (83%). The most common single substance group was opioids. All tested substances were associated with heavier lungs than controls, with the largest effect in the opioid group. Our findings show that several substances are associated with increased lung weight and that among intoxication deaths there is no difference in expected brain weight between substances. Hence, heavy lungs, without a reasonable explanation, should prompt a broad toxicological screening.

Sedan neurokirurgen Norman Guthkelch under början av 1970-talet formulerade hypotesen att skakningar av små barn – shaken baby syndrome – kan leda till blödningar i ögon och hjärna utan yttre skallskador, har forskningen kring skakvåld vidgats till att täcka in en rad olika fynd. Men det råder delade meningar om hur man ska diagnostisera och förebygga skakvåld. Forskningen och den alltför breda tolkningen av begreppet skakvåld har på senare tid börjat ifrågasättas allt mer, inte minst av Guthkelch själv.

I denna bok redogör Anders Eriksson och Niels Lynøe för det aktuella forskningsläget och varnar för att rådande konsensus inom skakvåldsforskningen tenderar att skapa situationer där oskyldiga föräldrar döms till misshandel av sina egna barn. I en utförlig genomgång av medicinhistoriska kontroverser visar författarna att vetenskapligt prestigetänkande ofta kan gå före fakta. 

This is a brief presentation of the evidence from a systematic literature review of the diagnostic accuracy in suspected traumatic shaking. The national and international reaction to this systematic literature review is also addressed, along with rebuttal of the criticism and an interpretation of the hostile reception of the review. We argue that despite the fact that a scientific controversy often includes competing theories about mechanisms, the shaken baby controversy also includes a controversy about correlation knowledge, because its function is to corroborate (or falsify) the applied theories about mechanisms. Moreover, we argue that long personal experience and groupthink within child protection teams have influenced the development of biased gold standards, resulting in turn in circular reasoning: hence most of the shaken baby literature is flawed.