4. Kivlin JD, Simons KB, Lazoritz
S, Ruttum MS.
Kivlin and colleagues performed a retrospective case series of 123 children
younger than 3 years of age who had subdural hematomas and a diagnosis of child
abuse. The determination of child abuse (shaken baby syndrome) was made
by a child advocacy physician and was based on the presence of subdural
hematomas, characteristic bone injuries and the absence of a history of compatible
functioning was determined by review of the medical charts. Twenty-two of
87 survivors (25 percent) were documented as having a “good” neurologic
outcome, defined as normal for age, at the last follow-up visit. Eight
patients (9 percent) were mildly impaired at the last follow-up visit;
impairments included attention deficit disorders or mild speech delay. Twenty-six
patients (30 percent) were severely impaired, with deficits including
hemiparesis, ataxia or severe developmental delay. Thirty-six patients (29
percent) died. There was no information available in the chart for 31
children (36 percent).
authors also recorded the visual function and eye examinations of patients seen
in follow-up by ophthalmologists, other specialists or pediatricians; the
authors noted visual outcome for patients at their last outpatient visit (only
60 percent of the final evaluations were by an ophthalmologist). Mean time
interval to follow-up was 21 months (range one month-seven years). Forty-nine
patients (72 percent) were reported to have “good” vision at their last
follow-up visit. Seventeen patients (25 percent) had “poor” vision.
Two additional patients reportedly had poor vision in one eye. There was
no follow-up information for 19 patients.
Cerebral visual impairment from cortical brain injury was the most
common cause of bilateral visual impairment (15 / 19 patients). Poor
visual outcome and poor neurologic outcome were highly correlated. Eye findings
that were associated with death included initial lack of visual response,
initial poor pupillary response and the presence of retinal hemorrhages.