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Traumatic shaking – The role of the triad in medical investigations of suspected traumatic shaking

A systematic review

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SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

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Published: Report no: 255 Registration no: UTV2014/254 ISBN: 978-91-85413-98-0
Errata
https://int.sbu.se/255e

Search term(s)

Infant Hematoma Subdural Retinal hemorrhage Brain edema Fractures Bone Rib fractures Child abuse Shaken baby syndrome

Summary of the results

The systematic review showed the following graded results:

  • There is limited scientific evidence that the triad1 and therefore its com­ponents can be associated with traumatic shaking (low quality evidence).
  • There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low quality evidence).

Limited scientific evidence (low quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support.

Insufficient scientific evidence (very low quality evidence) represents either a lack of studies, or situations when available studies are of low quality or show contradictory results.

Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.

1 Three components of a whole. The triad associated with SBS usually comprises subdural hematoma, retinal hemorrhages and encephalopathy.

Project group

Experts

  • Göran Elinder, Professor of Pediatrics, Karolinska Institutet, Stockholm, and Senior Consultant in Pediatrics
  • Anders Eriksson, Professor of Forensic Medicine, Umeå University, and Senior Consultant in Forensic Medicine, the National Board of Forensic Medicine
  • Boubou Hallberg, PhD, Karolinska Institutet, Stockholm, and Senior Consultant in Pediatrics and Neonatology, Karolinska University Hospital, Stockholm
  • Niels Lynøe, Senior Professor of Medical Ethics, Karolinska Institutet, Stockholm, and specialist in Family Medicine
  • Pia Maly Sundgren, Professor of Diagnostic Radiology, Lund University, and Senior Consultant in Neuroradiology, Skåne University Hospital, Lund
  • Måns Rosén, Adjunct Professor of Health Technology Assessment, Karolinska Institutet, Stockholm
  • Björn-Erik Erlandsson, External Collaborator, Biomechanical studies (Appendix 2), Professor of Medical Technology, Royal Institute of Technology, Stockholm

SBU

  • Frida Mowafi, Project Manager
  • Marianne Heibert-Arnlind, Project Manager until September 2015
  • Irene Edebert, Assistant Project Manager
  • Hanna Olofsson, Information Specialist 
  • Anna Attergren Granath, Project Administrator
  • Laura Lintamo, Analyst
  • Anna Björklöf, Communication Responsible
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