LONG-TERM OUTCOME IN INFANTS WITH THE SHAKING-IMPACT SYNDROME

Nonaccidental injury accounts for nearly one quarter of all hospital a dmissions for head injury in infancy, and is associated with significa nt morbidity and mortality. Long-term outcome in survivors, however, h as been incompletely studied. In this series, 84 infants 2 years of ag e and younger with the shaking-impact syndrome consecutively admitted to a single hospital between 1978 and 1988 were identified. A question naire detailing current medical, developmental, and behavioral status was developed, and attempts were made to locate the 62 children surviv ing the acute injury. Family instability and strict confidentiality re strictions precluded locating the majority of children, but 14 childre n with demographic and injury characteristics similar to those of the overall group were contacted at an average of 9 years after injury. Se ven children were severely disabled or vegetative, 2 were moderately d isabled, and 5 had a good outcome. Of the latter group, 3 had repeated grades and/or required tutoring. Acute factors associated with poor o utcome included unresponsiveness on admission, need for intubation, ag e less than 6 months, and bilateral or unilateral diffuse hypodensity on CT scan. All children with bilateral diffuse hypodensity and loss o f gray-white differentiation on CT scan remained blind, retarded, nonv erbal, and nonambulatory in spite of aggressive medical and surgical m anagement. This study suggests that the majority of children surviving the shaking-impact syndrome suffer major permanent morbidity, and tha t acute factors predicting long-term outcome may help guide aggressive ness of care.