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Co-existent features

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.



  • Amongst studies recording fractures:
    • skull fractures occurred predominantly amongst non-abusive head trauma (nAHT) cases as opposed to  abusive head trauma (AHT) cases AHT comparative 4,32,36,37 AHT non-comparative 2,8,11,16,18,19,21,26,31,33,40 nAHT comparative 4,14,32,36,37 nAHT non-comparative 1,12,15,17,23-25,28,34,40
    • rib fractures were recorded exclusively in AHT AHT comparative 4,7,10,36,37 AHT non-comparative 2,7,11,13,20,22,27,29-31,39,41
    • long bone were far more frequent amongst AHT than nAHT cases AHT comparative 4,7,10,36,37 AHT non-comparative 2,3,9,11,13,18,21,22,26,27,29-31,35,38,39 nAHT comparative 7,35-37
    • multiple fractures were far more frequent amongst AHT than nAHT cases AHT comparative 4,36,37 AHT non-comparative 2,11,13,19,21,22,27,29-31,39 nAHT comparative 36,37
    • One case of a three year old with perpetrator admitted shaking had interhemispheric subdural haemorrhage and cerebral oedema with no co-existent fractures 6
  • Other clinical features included clavicle fracture 27, corneal abrasion 38, bruising 5,7,20, bites and perineal injuries 27, and visceral injuries 7


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  1. Agrawal S, Peters MJ, Adams GG, Pierce CM. Prevalence of retinal haemorrhages in critically ill children. Pediatrics. 2012;129(6):e1388-e1396 [Pubmed]

  2. Arlotti SA, Forbes BJ, Dias MS, Bonsall DJ. Unilateral retinal hemorrhages in shaken baby syndrome. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2007;11(2):175-178 [Pubmed]
  3. Arnold RW. Macular hole without hemorrhages and shaken baby syndrome: practical medicolegal documentation of children's eye trauma. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2003;40(6):355-357 [Pubmed citation only]
  4. Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168 [Pubmed]
  5. Becker JC, Liersch R, Tautz C, Schlueter B, Andler W. Shaken baby syndrome: report on four pairs of twins. Child Abuse and Neglect. 1998;22(9):931-937 [Pubmed]
  6. Bell E, Shouldice M, Levin AV. Abusive head trauma: A perpetrator confesses. Child Abuse and Neglect. 2011;35(1):74-77 [Pubmed]

  7. Binenbaum G, Christian CW, Ichord RN, Ying GS, Simon MA, Romero K, Pollock AN, Forbes BJ. Retinal hemorrhage and brain injury patterns on diffusion-weighted magnetic resonance imaging in children with head trauma. Journal of AAPOS. 2013;17(6):603-8 [Pubmed]

  8. Biron D, Shelton D. Perpetrator accounts in infant abusive head trauma brought about by a shaking event. Child Abuse and Neglect. 2005;29(12):1347-1358 [Pubmed]
  9. Brown SM, Bradley JC. Hemorrhagic posterior vitreous detachment without intraretinal hemorrhage in a shaken infant. Archives of Ophthalmology. 2007;125(9):1301 [Pubmed citation only]
  10. Buys YM, Levin AV, Enzenauer RW, Elder JE, Letourneau MA, Humphreys RP, Mian M, Morin JD. Retinal findings after head trauma in infants and young children. Ophthalmology. 1992;99(11):1718-1723 [Pubmed]
  11. Carter JE, McCormick AQ. Whiplash shaking syndrome: retinal hemorrhages and computerized axial tomography of the brain. Child Abuse and Neglect. 1983;7(3):279-286 [Pubmed]
  12. Christian CW, Taylor AA, Hertle RW, Duhaime AC. Retinal hemorrhages caused by accidental household trauma. Journal of Pediatrics. 1999;135(1):125-127 [Pubmed]
  13. Drack AV, Petronio J, Capone A. Unilateral retinal hemorrhages in documented cases of child abuse. American Journal of Ophthalmology. 1999;128(3):340-344 [Pubmed]
  14. Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108(3):636-646 [Pubmed]
  15. Forbes BJ, Cox M, Christian CW. Retinal hemorrhages in patients with epidural hematomas. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2008;12(2):177-180 [Pubmed]
  16. Gilles EE, Nelson MD Jr. Cerebral complications of nonaccidental head injury in childhood. Pediatric Neurology. 1998;19(2):119-128 [Pubmed]
  17. Gnanaraj L, Gilliland MGF, Yahya RR, Rutka JT, Drake J, Dirks P, Levin AV. Ocular manifestations of crush head injury in children. Eye. 2007;21(1):5-10 [Pubmed]
  18. Greenwald MJ, Weiss A, Oesterle CS, Friendly DS. Traumatic retinoschisis in battered babies. Ophthalmology. 1986;93(5):618-625 [Pubmed]
  19. Haviland J, Russell RI. Outcome after severe non-accidental head injury. Archives of Disease in Childhood. 1997;77(6):504-507 [Pubmed]
  20. Healey K, Schrading W. A case of shaken baby syndrome with unilateral retinal hemorrhage with no associated intracranial hemorrhage. American Journal of Emergency Medicine. 2006;24(5):616-617 [Pubmed citation only]
  21. Helfer RE, Scheurer SL, Alexander R, Reed J,Slovis TL. Trauma to the bones of small infants from passive exercise: a factor in the etiology of child abuse. Journal of Pediatrics. 1984;104(1):47-50 [Pubmed]
  22. Kapoor S, Schiffman J, Tang R, Kiang E, Li H, Woodward J. The significance of white-centered retinal hemorrhages in the shaken baby syndrome. Pediatric Emergency Care. 1997;13(3):183-185 [Pubmed]
  23. Lantz PE, Sinal SH, Stanton CA, Weaver RG Jr. Perimacular retinal folds from childhood head trauma. British Medical Journal. 2004;328(7442):754-756 [Pubmed]
  24. Lueder GT, Turner JW, Paschall R. Perimacular retinal folds simulating nonaccidental injury in an infant. Archives of Ophthalmology. 2006;124(12):1782-1783 [Pubmed citation only]
  25. Madsen PH. Traumatic retinal angiopathy. Report of six cases of Purtscher's disease. Acta Ophthalmologica. 1965;43(6):776-786 [Pubmed citation only]
  26. McCabe CF, Donahue SP. Prognostic indicators for vision and mortality in shaken baby syndrome. Archives of Ophthalmology. 2000;118(3):373-377 [Pubmed]
  27. Morad Y, Avni I, Benton SA, Berger RP, Byerley JS, Coffman K, Greeley CS, Gustavson EE, Levitt CJ, Lenane A, Topley J, Levin AV. Normal computerized tomography of brain in children with shaken baby syndrome. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2004;8(5):445-450 [Pubmed]
  28. Moran K, Reddie I, Jacobs M. Severe haemorrhagic retinopathy and traumatic retinoschisis in a 2 year old infant, after an 11 metre fall onto concrete. Acta Paediatrica. 2008;97(suppl 459):149 Full article published: Reddie IC, Bhardwaj G, Dauber SL, Jacobs MB, Moran KT. Bilateral retinoschisis in a 2-year-old following a three-storey fall. Eye. 2010;24(8):1426-1427 [Pubmed citation only]
  29. Ogershok PR, Jaynes ME, Hogg JP. Delayed papilledema and hydrocephalus associated with shaking impact syndrome. Clinical Pediatrics. 2001;40(6):351-354 [Pubmed citation only]
  30. Oral R, Yagmur F, Nashelsky M, Turkmen M, Kirby P. Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse. Pediatric Emergency Care. 2008;24(12):816-821 [Pubmed]
  31. Pitetti RD, Maffei F, Chang K, Hickey R, Berger R. Pierce MC. Prevalence of retinal hemorrhages and child abuse in children who present with an apparent life-threatening event. Pediatrics. 2002;110(3):557-562 [Pubmed]
  32. Sturm V, Knecht PB, Landau K, Menke MN. Rare retinal haemorrhages in translational accidental head trauma in children. Eye. 2009;23(7):1535-41 [Pubmed]

  33. Sturm V, Landau K, Menke MN. Optical coherence tomography findings in Shaken Baby syndrome. American Journal of Ophthalmology. 2008;146(3):363-368 [Pubmed]
  34. Trenchs V, Curcoy AI, Morales M, Serra A, Navarro R, Pou J. Retinal haemorrhages in head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age. Child's Nervous System. 2008;24(7):815-820 [Pubmed]
  35. Vinchon M, De Foort-Dhellemmes S, Desurmont M, Delestret I. Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases. Child's Nervous System. 2010;26(5):637-645. [Pubmed]

  36. Vinchon M, Defoort-Dhellemmes S, Desurmont M, Dhellemmes P. Accidental and nonaccidental head injuries in infants: a prospective study. Journal of Neurosurgery. 2005;102(4 Suppl):380-384 [Pubmed]
  37. Vinchon M, Defoort-Dhellemmes S, Noulé N, Duhem R, Dhellemmes P. Accidental or non-accidental brain injury in infants. Prospective study of 88 cases [French]. Presse Médicale. 2004;33(17):1174-1179 [Pubmed]
  38. Wahl NG, Woodall BN. Hypothermia in shaken infant syndrome. Pediatric Emergency Care. 1995;11(4):233-234 [Pubmed citation only]
  39. Waterhouse W, Enzenauer RW, Parmley VC. Inflammatory orbital tumor as an ocular sign of a battered child. American Journal of Ophthalmology. 1992;114(4):510-512 [Pubmed citation only]
  40. Watts P, Obi E. Retinal folds and retinoschisis in accidental and non-accidental head injury. Eye. 2008;22(12):1514-1516 [Pubmed]
  41. Weis A, Kodsi SR, Rubin SE, Esernio-Jenssen D, Ferrone PJ, McCormick SA. Subretinal hemorrhage masquerading as a hemorrhagic choroidal detachment in a case of nonaccidental trauma. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2007;11(6):616-617 [Pubmed]


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