Thiblin Ingemar, Wingren Carl Johan, Emad Jacob Andersson, Tamsen Fredrik
Department of Surgical Sciences, Forensic Science, Uppsala University, Uppsala, Sweden.
Department of Forensic Medicine, Section of Forensic Pathology, University of Copenhagen, Copenhagen, Denmark.
Forensic Sci Int Synerg. 2025 Jun 30;11:100618. doi: 10.1016/j.fsisyn.2025.100618. eCollection 2025 Dec.
Subdural hemorrhage, retinal hemorrhages, and encephalopathy are associated with the medical diagnosis of abusive head trauma. These findings have also been observed in children exposed to admitted or witnessed shaking. There are various suggested mechanisms behind these findings. One mechanism is exclusive to intentional shaking, while the other suggested mechanisms are compatible with both intentional and accidental violence as well as an underlying illness. We performed a systematic literature review of case reports on triad findings with subsequent analysis on the empirical consequences of three mechanistic hypotheses: (1) the outcome components arise independently following acceleration-deceleration forces during shaking; (2) the outcome components are partially dependent and caused by pathophysiological mediators following hypoxia caused by damage to the brainstem or cervical spinal cord by shaking; (3) the outcome factors are partially dependent and are caused by re-bleeding triggered by shaking in chronic subdural hematoma. From a total of 9628 articles, we identified twelve publications including in total 100 cases that met the inclusion criteria. We identified no sufficiently detailed case report, but nine cases had information that allowed for tentative testing of the hypotheses. Three cases had findings consistent with that triad findings are partially dependent and related to chronic subdural re-bleeding (hypothesis 3), whereas no case provided support for the other hypotheses. Thus, published cases do not provide the information needed to understand the mechanism underlying triad findings in infants subjected to shaking.
硬膜下出血、视网膜出血和脑病与虐待性头部创伤的医学诊断相关。在遭受摇晃（无论是自己承认的还是目睹的）的儿童中也观察到了这些发现。这些发现背后有各种推测的机制。一种机制是故意摇晃所特有的，而其他推测的机制既与故意和意外暴力有关，也与潜在疾病有关。我们对关于三联征发现的病例报告进行了系统的文献综述，随后对三种机制假说的实证结果进行了分析：（1）在摇晃过程中，加速-减速力作用后，结果成分独立出现；（2）结果成分部分相关，是由摇晃导致脑干或颈脊髓损伤引起缺氧后，由病理生理介质导致的；（3）结果因素部分相关，是由慢性硬膜下血肿摇晃引发的再出血导致的。在总共9628篇文章中，我们确定了12篇出版物，总共包括100例符合纳入标准的病例。我们没有找到足够详细的病例报告，但有9例病例的信息允许对这些假说进行初步检验。3例病例的发现与三联征发现部分相关且与慢性硬膜下再出血有关（假说3），而没有病例支持其他假说。因此，已发表的病例并未提供理解遭受摇晃的婴儿三联征发现背后机制所需的信息。
