We hypothesize that apnea induced by shaking or by shaking combined with impact plays a major role in the pathophysiology of nonaccidental head trauma and accounts for the poor outcome in this subgroup of patients. In a retrospective study of 28 children who suffered significant nonaccidental head injury, 57% had a history of apnea prior to hospitalization, 82% were intubated upon admission, and 71% had early seizures. For further evidence of ischemia and hypoxia, the first recorded blood pressure was <80 in 50% and the arterial pH <7.3 in 54%. Seventy-one percent had diffuse brain swelling which is characteristic of cerebral hypoxia and/or ischemia on the first CT scan. None of the children who had clinical evidence of cerebral hypoxia or ischemia had a good outcome. We conclude that trauma-induced apnea causes cerebral hypoxia and/or ischemia which is more fundamental to outcome than the mechanism of injury (shaken vs. shaken with impact), subdural hemorrhage, subarachnoid hemorrhage, diffuse axonal injury, parenchymal shear, or brain contusion.
Dennis L. Johnson, MD, Department of Surgery, Division of Pediatric Neurosurgery, Children’s Hospital, Milton S. Hershey Medical Center, Penn State University, PO Box 850, Hershey, PA 17033 (USA)
Received: May 22, 1995
Accepted in revised form: December 4, 1995
Published online: March 06, 2008
Number of Print Pages : 6
Vol. 23, No. 6, Year 1995 (Cover Date: 1995)
Journal Editor: Frim D.M. (Chicago, Ill.)
ISSN: 1016–2291 (Print), eISSN: 1423–0305 (Online)
For additional information: http://www.karger.com/PNE
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