Katelyn Stebbins1, Nasser Mohammed2, Aashit Shah2
1Fralin Biomedical Research Institute at VTC, 2Carilion Clinic
Objective:
The present study aims to elucidate the factors contributing to poor outcomes in patients with acute seizures following Shaken Baby Syndrome (SBS).
Background:
SBS is the most common cause of severe neurological injury resulting from child abuse and is associated with subdural and retinal hemorrhages. Seizures are a common yet underdiagnosed feature of this syndrome and are associated with poor outcomes.
Design/Methods:
We retrospectively identified patients with SBS and seizures who were diagnosed between 2015-2020. Detailed chart review was performed under IRB-approved study criteria. Demographic, clinical, imaging, lab, and neurophysiology studies information was systematically collected. Logistic regression analysis was used to evaluate factors contributing to poor outcomes.
Results:
A total of 23 patients with acute seizures following SBS were included. The mean age was 7 months (range 3 weeks - 4 years). Six(26%) patients had a presenting GCS of 7 or less, while status epilepticus presented in 7(30%) patients. All included patients had acute traumatic subdural hematoma, retinal hemorrhage, and seizures in the acute period. Overall mortality was 2(9%). Logistic regression analysis identified craniotomy (p:0.01, OR:215.00; 95% CI 3.45-13408.47), SDH thickness >1 cm (p:0.02, OR:68.33; 95% CI 2.15-2173.12), midline shift >1 mm (p:0.03, OR:39.00; 95% CI 1.42-1067.60), and age >24 months (p:0.01, OR:215.00; 95% CI 3.45-13408.47) as predictors of mortality in both univariate and multivariate analysis. Of note, 19(83%) patients had an elevated serum glucose on presentation.
Conclusions:
Seizures in Shaken Baby Syndrome are associated with acute traumatic subdural hematoma, and about 1 in 3 children will develop status epilepticus. Patients with craniotomy to evacuate SDH, SDH thickness >1 cm, midline shift >1 mm, and older age at the time of injury have a worse prognosis.