Role of apnea in nonaccidental head injury.
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.
Johnson
D L
DL
Department of Surgery, Children's Hospital, Milton S. Hershey Medical Center, Penn State University, Hershey, Pa 17033, USA.
Boal
D
D
Baule
R
R
D001049:Apnea / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D001929:Brain Edema / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D002649:Child Abuse / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D007223:Infant; D008297:Male; D009460:Neurologic Examination; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014911:Whiplash Injuries / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology