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

Research output: Contribution to journalReview article


The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results: There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) 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.


  • Göran Elinder
  • Anders Eriksson
  • Boubou Hallberg
  • Niels Lynøe
  • Pia Maly Sundgren
  • Måns Rosén
  • Ingemar Engström
  • Björn Erik Erlandsson
External organisations
  • Umeå University
  • Karolinska Institutet
  • Skåne University Hospital
  • Örebro University
  • KTH Royal Institute of Technology
  • Swedish National Board of Forensic Medicine
  • Karolinska University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Pediatrics


  • Brain oedema, Child abuse, Infant, Retinal haemorrhage, Shaken Baby Syndrome, Subdural haematoma
Original languageEnglish
Pages (from-to)3-23
Number of pages21
JournalActa Paediatrica, International Journal of Paediatrics
Publication statusPublished - 2018 Aug 26
Publication categoryResearch