Diagnostic criteria of shaking 2017: A crucial advance into knowledge on the Shaken baby syndrome (SBS)

Abstract

Shaken baby syndrome constitutes a major public health risk. In 2011, guidelines have been established by the High Authority of Health and the SOFMER to help health professionals cope with the diagnosis of SBS. The method used was to compare the most frequent lesions observed in SBS, which are multifocal subdural hematoma and retinal haemorrhages with the lesions induced by mechanism often pointed out by the adults when the child is brought to hospital or during the judicial process. If the lesions induced were the same as those of SBS or therefore the mechanism was acceptable. If not the mechanismwas rejected. From these results, diagnostic criteria of shaking were established based exclusively on the lesions observed and on the history related by the caretaker to explain the child's state and not on the risk factors. Moreover, from 2011 it has been possible to go further(study of the literature and experts’ opinion). Other mechanisms have been brought forward: vaccines, apparent life-threatening events (ALTEs)… And the knowledge on the type of lesions in case of SBS has also improved: type and location of the SDH/lesions newly described as the rupture thrombosis of the bridging veins, intra thecal SDH … The diagnostic criteria were updated from these results. For an infant, at the end of the clinical and radiological assessments, whatever the initial symptoms, after having ruled out differential diagnosis (infection/metabolic disease) and if the clinical history is absent, incoherent, changes over time or is incompatible with the observed lesions or the child's age, these new criteria let us make the diagnosis or consider it as probable. These guidelines to professionals make it easier to diagnose shaken baby syndrome. But these diagnostic criteria have to be known by professionals. Consequently better training is the key: the initial and continuing training must be reinforced. http://www.has-sante.fr/portail/jcms/c_1095929/recommandation-syndrome-du-bebe-secoue .