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Diagnostics
Volume 16
Issue 2
10.3390/diagnostics16020319
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Review

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

by
Fabio Del Duca
1,
Gianpietro Volonnino
2,
Biancamaria Treves
3,
Alessandra De Matteis
3,
Nicola Di Fazio
4,*,
Raffaele La Russa
5,
Paola Frati
3 and
Aniello Maiese
3
1
Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
2
Department of Medicine, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
3
Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
4
Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy
5
Department of Clinical Medicine, Public Health, Life Sciences, Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
*
Author to whom correspondence should be addressed.
Diagnostics 2026, 16(2), 319; https://doi.org/10.3390/diagnostics16020319
Submission received: 24 December 2025 / Revised: 5 January 2026 / Accepted: 12 January 2026 / Published: 19 January 2026
(This article belongs to the Special Issue Decoding Complexity in Traumatic Injury Diagnosis: Forensic Approaches)
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Abstract

Major traumas result from the application of multiple force components that, in adulthood, can lead to high mortality and morbidity. In forensic practice, pathological consequences arising from the rapid flexion–extension of an adult victim’s soma are observed, with typical intracranial and ophthalmological findings. The totality of these findings allows for a contribution to the definition of the Shaken Adult Syndrome (SAS). A comprehensive review, employing the PRISMA methodology, was conducted on international works pertaining to SAS. This resulted in the identification of six scientific papers, which were analyzed separately. It emerged that, for the diagnosis of SAS, the same diagnostic triad as Shaken Baby Syndrome is valid, comprising subdural hemorrhages, retinal hemorrhages, and encephalopathy. This syndrome appears to encompass a broad spectrum of pathological conditions, ranging from whiplash to diffuse axonal injury (DAI). At the conclusion of this work, we proposed a diagnostic flowchart that allows for suspected predictive diagnosis of SAS, both in live patients presenting to emergency medical services and in post-mortem cadavers. For this purpose, the collection of anamnesis and circumstantial data, the detection of external injuries, and the execution of cranial CT scans will be essential. Ultimately, microscopic examinations of the brain with specific immunomarkers and of ocular structures will enable the identification of pathognomonic findings for SAS.
Keywords: shaken adult syndrome; domestic violence; abusive head trauma; head trauma; subdural hemorrhage; retinal hemorrhage; diffuse axonal injury shaken adult syndrome; domestic violence; abusive head trauma; head trauma; subdural hemorrhage; retinal hemorrhage; diffuse axonal injury

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MDPI and ACS Style

Del Duca, F.; Volonnino, G.; Treves, B.; De Matteis, A.; Di Fazio, N.; La Russa, R.; Frati, P.; Maiese, A. Shaken Adult Syndrome: Defining a New Traumatic Entity with an Evidence-Based Approach. Diagnostics 2026, 16, 319. https://doi.org/10.3390/diagnostics16020319

AMA Style

Del Duca F, Volonnino G, Treves B, De Matteis A, Di Fazio N, La Russa R, Frati P, Maiese A. Shaken Adult Syndrome: Defining a New Traumatic Entity with an Evidence-Based Approach. Diagnostics. 2026; 16(2):319. https://doi.org/10.3390/diagnostics16020319

Chicago/Turabian Style

Del Duca, Fabio, Gianpietro Volonnino, Biancamaria Treves, Alessandra De Matteis, Nicola Di Fazio, Raffaele La Russa, Paola Frati, and Aniello Maiese. 2026. "Shaken Adult Syndrome: Defining a New Traumatic Entity with an Evidence-Based Approach" Diagnostics 16, no. 2: 319. https://doi.org/10.3390/diagnostics16020319

APA Style

Del Duca, F., Volonnino, G., Treves, B., De Matteis, A., Di Fazio, N., La Russa, R., Frati, P., & Maiese, A. (2026). Shaken Adult Syndrome: Defining a New Traumatic Entity with an Evidence-Based Approach. Diagnostics, 16(2), 319. https://doi.org/10.3390/diagnostics16020319

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