Insufficient evidence for ‘shaken baby syndrome’ – a systematic review

@article{Lyne2017InsufficientEF,
  title={Insufficient evidence for ‘shaken baby syndrome’ – a systematic review},
  author={Niels Lyn{\o}e and Göran Elinder and Boubou Hallberg and M{\aa}ns Ros{\'e}n and Pia C. Maly Sundgren and Anders Eriksson},
  journal={Acta Paediatrica},
  year={2017},
  volume={106}
}
Shaken baby syndrome has typically been associated with findings of subdural haematoma, retinal haemorrhages and encephalopathy, which are referred to as the triad. During the last decade, however, the certainty with which the triad can indicate that an infant has been violently shaken has been increasingly questioned. The aim of this study was to determine the diagnostic accuracy of the triad in detecting that an infant had been shaken. The literature search was performed using PubMed, Embase… 
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References

SHOWING 1-10 OF 73 REFERENCES
The “Shaken Baby” syndrome: pathology and mechanisms
TLDR
The pathology and mechanisms of the three physiologically associated findings which constitute the “triad” and are seen in infants suffering from a wide range of non-traumatic as well as traumatic conditions are focused on.
A Witnessed Short Fall Mimicking Presumed Shaken Baby Syndrome (Inflicted Childhood Neurotrauma)
TLDR
This paper presents critical information upon which the authors are often required to act and includes more clinical information than most of the previous studies in this area.
Retinal hemorrhages and shaken baby syndrome: an evidence-based review.
The shaken baby syndrome: review of 10 cases.
  • Lee, So, Fong, Luk
  • Medicine
    Hong Kong medical journal = Xianggang yi xue za zhi
  • 1999
TLDR
Peripheral signs are uncommon and a high degree of suspicion is needed for the management to be successful and medical practitioners should be alert to the occurrence of abusive head injury in children.
Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review
TLDR
It is shown that apnoea and retinal haemorrhage have a high odds ratio for association with iBI, and key features that should be recorded in the assessment of children where iBI is suspected and may help clinicians to define the likelihood of iBI.
Funduscopic lesions associated with mortality in shaken baby syndrome.
  • M. Mills
  • Medicine
    Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus
  • 1998
Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases
TLDR
This study confirms the high diagnostic value of RH, SDH, and signs of impact for the differential diagnosis between AT and IHI, and examines prospectively corroborated cases of head injuries in infants.
Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses.
Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review
TLDR
The authors' systematic review confirms that although certain patterns of RH were far commoner in AHT, namely large numbers of RH in both the eyes, present in all layers of the retina, and extension into the periphery, there was no retinal sign that was unique to abusive injury.
A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma.
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