Gilliland M G, Folberg R
Department of Pathology, East Carolina University School of Medicine, Greenville, NC, USA.
J Forensic Sci. 1996 Jan;41(1):114-6.
One study has questioned the validity of shaking as a mechanism of head injury in children. A prospective, postmortem study investigated 80 deaths from head trauma to identify the roles of shaking and direct impacts. Evidence of shaking was defined as two or more of the following criteria: 1) finger marks and/or rib fractures, 2) subdural and/or subarachnoid hemorrhage, or 3) a history of vigorous shaking. Shaking to the exclusion of other head trauma was defined as the presence of two or more of the above criteria together with the complete absence of scalp or skull injuries. Nine (11.3%) of the 80 study deaths qualified as exclusively shaking injuries by this definition. Thirty (37.5%) of the deaths had direct injuries as well as two of the criteria of shaking; these deaths were classified as combined shaking and blunt trauma. Forty-one (51.3%) of the deaths had impact injuries without having two of the criteria of shaking. We reviewed the extent of ocular injuries in all the cases. We found ocular hemorrhages with increased frequency in cases with two or more of the criteria of shaking compared to cases with only impact mechanism of injury. Retinal hemorrhages continue to show themselves to be a good marker of infants injured by vigorous, intentional shaking. This study likewise confirms the observations of others that most, but not all, shaken babies have impact injuries as well.
一项研究对摇晃作为儿童头部受伤机制的有效性提出了质疑。一项前瞻性尸检研究调查了80例头部外伤死亡病例，以确定摇晃和直接撞击的作用。摇晃的证据被定义为符合以下两项或更多标准：1）手指印和/或肋骨骨折，2）硬膜下和/或蛛网膜下腔出血，或3）剧烈摇晃病史。排除其他头部外伤的摇晃被定义为存在两项或更多上述标准且完全没有头皮或颅骨损伤。根据这一定义，80例研究死亡病例中有9例（11.3%）被认定为单纯摇晃损伤。30例（37.5%）死亡病例既有直接损伤又有两项摇晃标准；这些死亡病例被归类为摇晃与钝性创伤合并。41例（51.3%）死亡病例有撞击伤但不符合两项摇晃标准。我们回顾了所有病例的眼部损伤程度。我们发现，与仅有撞击损伤机制的病例相比，符合两项或更多摇晃标准的病例中眼部出血的频率更高。视网膜出血仍然是受剧烈、故意摇晃伤害的婴儿的一个良好标志。这项研究同样证实了其他人的观察结果，即大多数（但不是全部）受摇晃婴儿也有撞击伤。
