Long-term outcome in infants with the shaking-impact syndrome
Long-term outcome in infants with the shaking-impact syndrome
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DOI：
10.1159/000121058
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发表时间：
1996-06-01
影响因子：
0.7
通讯作者：
Seidl, T
中科院分区：
文献类型：
--
作者：
Duhaime, AC;Christian, C;Seidl, T
非意外伤害占所有婴儿头部损伤住院人数的近四分之一，并与显著的发病率和死亡率有关。然而，对幸存者的长期结局还没有完全研究。在这个系列中，从1978年到1988年连续在一家医院住院的84名2岁及2岁以下的婴儿被证实患有震动冲击综合征。开发了一份详细说明当前医疗、发育和行为状况的问卷，并试图找到62名在急性损伤中幸存下来的儿童。家庭不稳定和严格的保密限制使大多数儿童无法找到，但14名具有与整个群体相似的人口统计和受伤特征的儿童在受伤后平均9年得到联系。7例重度残疾或植物人，2例中度残疾，5例预后良好。在后一组中，有3人有重复成绩和/或要求辅导。与不良预后相关的急性因素包括入院时无反应、需要插管、年龄小于6个月、CT扫描显示双侧或单侧弥漫性低密度。尽管进行了积极的内科和外科治疗，所有CT上双侧弥漫性低密度和灰白色区分丧失的儿童仍然是失明、迟缓、不能说话和不能行走的。这项研究表明，大多数在震动冲击综合征中幸存下来的儿童患有主要的永久性疾病，预测长期结果的急性因素可能有助于指导积极的护理。
Nonaccidental injury accounts for nearly one quarter of all hospital admissions for head injury in infancy, and is associated with significant morbidity and mortality. Long-term outcome in survivors, however, has been incompletely studied. In this series, 84 infants 2 years of age and younger with the shaking-impact syndrome consecutively admitted to a single hospital between 1978 and 1988 were identified. A questionnaire detailing current medical, developmental, and behavioral status was developed, and attempts were made to locate the 62 children surviving the acute injury. Family instability and strict confidentiality restrictions precluded locating the majority of children, but 14 children with demographic and injury characteristics similar to those of the overall group were contacted at an average of 9 years after injury. Seven children were severely disabled or vegetative, 2 were moderately disabled, and 5 had a good outcome. Of the latter group, 3 had repeated grades and/or required tutoring. Acute factors associated with poor outcome included unresponsiveness on admission, need for intubation, age less than 6 months, and bilateral or unilateral diffuse hypodensity on CT scan. All children with bilateral diffuse hypodensity and loss of gray-white differentiation on CT scan remained blind, retarded, nonverbal, and nonambulatory in spite of aggressive medical and surgical management. This study suggests that the majority of children surviving the shaking-impact syndrome suffer major permanent morbidity, and that acute factors predicting long-term outcome may help guide aggressiveness of care.