# Spread of “triad diagnostics” in suspected Shaken Baby Syndrome

## TL;DR

This paper presents two misdiagnosed cases of Shaken Baby Syndrome in Poland, highlighting the unreliability of the triad diagnostic method and its potential legal and medical consequences.

## Contribution

The paper introduces two new case studies that challenge the validity of the triad diagnostic method for Shaken Baby Syndrome.

## Key findings

- Triad findings may result from benign external hydrocephalus rather than violent shaking.
- Misdiagnosis of SBS can lead to delayed treatment and permanent brain damage.
- The traditional SBS hypothesis lacks solid scientific evidence and has uneven global acceptance.

## Abstract

We describe here possibly the first two cases of alleged Shaken Baby Syndome (SBS) in Poland, based solely on “triad findings” (encephalopathy symptoms, subdural hemorrhage/SDH, and retinal hemorrhages/RH), but without signs of relevant trauma. Case #1, a 7-week-old infant girl, is suggested to represent a case of rebleeding in a birth-related SDH. In case #2, a 13-week-old infant boy, we claim that the triad findings were related to benign external hydrocephalus (BEH). Unjustified belief that triad findings are always caused by violent shaking may, apart from the obvious legal and social effects, in case #2 also have contributed to delayed adequate treatment of increased intracranial pressure and subsequent signs of permanent brain damage.

We discuss also the traditional SBS hypothesis and its lack of solid scientific evidence, and the uneven geographical acceptance of and belief in this unvalidated hypothesis.

•Two cases of suspected Shaken Baby Syndrome are presented, both misdiagnosed.•The lack of reliability of the “triad diagnostic method” is emphasized.•The most common cause of triad findings is probably BEH/BESS.•Both over- and underdiagnosis of suspected abuse can have disastrous effects.

Two cases of suspected Shaken Baby Syndrome are presented, both misdiagnosed.

The lack of reliability of the “triad diagnostic method” is emphasized.

The most common cause of triad findings is probably BEH/BESS.

Both over- and underdiagnosis of suspected abuse can have disastrous effects.