gms | German Medical Science

The aim of the study was to evaluate the prognosis factors in shaken baby syndrom, to determine the clinical and paraclinical features correleted with bad vital or functional evolution.

We have analysed 404 cases of shaken baby syndrom, reffered in our department between 1994 and 2004. The mean follow-up was 2,5 years after diagnosis of subdural hematoma. The functional evaluation was performed using the folowing scale : Grade 1: no neurologic trouble ; 2: light mental delay requiring psychometric support ; 3: severe mental delay requiring care in institution ; 4: full cognitive deficit requiring continuous care ; and grade 5: death.

The distribution within the different grades was : Grade 1: 46% 2: 23% 3: 14% 4:7 % 5: 10%. Several factors have been identified as being correlated with bad prognosis : epilepsia during the acute period, status epilepticus, electroencephalogaphic abnormality, cerebral parenchymal hypodensity, hyperdensity of the subdural hematoma, pericerebral vertex hyperdensity, intraocular hemorrhage. From these observations, we have elaborated a simplified prognosis scale (SPS). This SPS ranged between 2 and 10, is the result of addition of a clinical score (1: non neurologic deficit ; 2: seizure ; 3: focal deficit ; 4: intubation required ; 5: status epilepticus) and a scanographic score (1: hypo/isodense hematoma ; 2: mixous with hyperdense component less 1cm ; 3: more 1cm ; 4: hyperdense hematoma ; 5: parenchymal hypodensity) Mortality was nil for SPS less than 6, and 51% for SPS 10; Children were asymptomatics in 80% for SPS 2, and 0% for SPS 10. The distribution within the different evaluation grades was correlated with the SPS level.

At the initial period of the hospitalisation, clinical and scannographic features in a simplified prognosis scale, can give reliable evaluation about the long-term neurologic evolution of shaken baby syndrom.