Citation

Leestma JE. J. Am. phys. surg. 2006; 11(1): 14-16.

Affiliation

Children’s Memorial Hospital of Northwestern University Medical Center, Chicago, IL, USA

Copyright

(Copyright © 2006, Association of American Physicians and Surgeons)

DOI

unavailable

PMID

unavailable

Abstract

The concept that a certain constellation of findings develops immediately after a baby is shaken, with no impact to the head, is based solely on confessions or admissions by alleged perpetrators. The reliability of confessions in the setting of interrogation by law-enforcement officials is questionable. A review of the literature reveals very few cases of admissions of "pure" shaking. Methodologic flaws preclude any definitive conclusions about causation from these cases.

The confessions or admissions of a perpetrator are at best tenuous support for the shaking mechanism for infantile head injury. A critical appraisal of any literature that proposes a causal mechanism of shaking for brain injury must include an evaluation of case selection methodology, population or sample size, possible case control issues, data analysis methods, and whether the conclusions reached are justified by the data presented.

Another vital issue, often overlooked, is a critical evaluation of literature cited. Unless the reader is very well informed on the issues and is intimately familiar with the literature, this component of an informed appraisal of an article almost never gets done, and the reader may accept the conclusions uncritically.