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Shaken Adult Syndrome: Defining a New Traumatic Entity with an Evidence-Based Approach.

Fabio Del Duca1, Gianpietro Volonnino2, Biancamaria Treves3

  • 1Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy.

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Summary

Shaken Adult Syndrome (SAS) involves severe head trauma in adults, presenting with intracranial and eye injuries. Diagnosis relies on subdural and retinal hemorrhages, and encephalopathy, similar to Shaken Baby Syndrome.

Keywords:
abusive head traumadiffuse axonal injurydomestic violencehead traumaretinal hemorrhageshaken adult syndromesubdural hemorrhage

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Area of Science:

  • Forensic Pathology
  • Neurology
  • Ophthalmology

Background:

  • Major traumas in adults can cause high mortality and morbidity.
  • Forensic analysis reveals pathological consequences from rapid head flexion-extension injuries.
  • These findings contribute to defining Shaken Adult Syndrome (SAS).

Purpose of the Study:

  • To define Shaken Adult Syndrome (SAS) based on existing literature.
  • To establish diagnostic criteria for SAS in adult trauma victims.
  • To propose a diagnostic flowchart for identifying SAS in clinical and post-mortem settings.

Main Methods:

  • Comprehensive literature review using PRISMA methodology.
  • Analysis of six identified scientific papers on SAS.
  • Review of diagnostic triads and pathological findings associated with adult head trauma.

Main Results:

  • The diagnostic triad for SAS includes subdural hemorrhages, retinal hemorrhages, and encephalopathy.
  • SAS encompasses a spectrum of injuries, from whiplash to diffuse axonal injury (DAI).
  • A diagnostic flowchart for suspected SAS was proposed.

Conclusions:

  • The diagnostic triad for Shaken Baby Syndrome is applicable to Shaken Adult Syndrome.
  • A systematic approach involving clinical data, imaging, and microscopic examination aids SAS diagnosis.
  • The proposed flowchart facilitates early and accurate diagnosis of SAS in emergency and forensic contexts.