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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 and the Cochrane Library up to October 15, 2015. Relevant publications were assessed for the risk of bias using the <jats:styled-content style=\"fixed-case\">QUADAS<\/jats:styled-content> tool and were classified as having a low, moderate or high risk of bias according to predefined criteria. The reference standards were confessions or witnessed cases of shaking or accidents. The search generated 3773 abstracts, 1064 were assessed as possibly relevant and read as full texts, and 30 studies were ultimately included. Of these, 28 were assessed as having a high risk of bias, which was associated with methodological shortcomings as well as circular reasoning when classifying shaken baby cases and controls. The two studies with a moderate risk of bias used confessions and convictions when classifying shaken baby cases, but their different designs made a meta\u2010analysis impossible. None of the studies had a low risk of bias.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The systematic review indicates that there is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low\u2010quality evidence). It was also demonstrated that there is limited scientific evidence that the triad and therefore its components can be associated with traumatic shaking (low\u2010quality evidence).<\/jats:p>","DOI":"10.1111\/apa.13760","type":"journal-article","created":{"date-parts":[[2017,1,28]],"date-time":"2017-01-28T01:07:09Z","timestamp":1485565629000},"page":"1021-1027","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":119,"title":["Insufficient evidence for \u2018shaken baby syndrome\u2019 \u2013 a systematic review"],"prefix":"10.1111","volume":"106","author":[{"given":"Niels","family":"Lyn\u00f8e","sequence":"first","affiliation":[{"name":"Stockholm Centre for Healthcare Ethics Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6ran","family":"Elinder","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education S\u00f6dersjukhuset Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boubou","family":"Hallberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e5ns","family":"Ros\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Learning, Informatics, Management and Ethics Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Sundgren","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Clinical Sciences Lund University Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Eriksson","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Rehabilitation Forensic Medicine Ume\u00e5 University Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5759.430"},{"key":"e_1_2_10_3_1","unstructured":"ElinderG ErikssonA HallbergB Lyn\u00f6eN Ros\u00e9nM SundgrenP.Traumatic shaking. 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