Outcomes in Children with Shaken Baby Syndrome and Seizures (P14-9.009)

Abstract

<h3>Objective:</h3> The present study aims to elucidate the factors contributing to poor outcomes in patients with acute seizures following Shaken Baby Syndrome (SBS). <h3>Background:</h3> SBS is the most common cause of severe neurological injury resulting from child abuse and is associated with subdural and retinal hemorrhages. Seizures are a common yet underdiagnosed feature of this syndrome and are associated with poor outcomes. <h3>Design/Methods:</h3> We retrospectively identified patients with SBS and seizures who were diagnosed between 2015–2020. Detailed chart review was performed under IRB-approved study criteria. Demographic, clinical, imaging, lab, and neurophysiology studies information was systematically collected. Logistic regression analysis was used to evaluate factors contributing to poor outcomes. <h3>Results:</h3> A total of 23 patients with acute seizures following SBS were included. The mean age was 7 months (range 3 weeks - 4 years). Six(26%) patients had a presenting GCS of 7 or less, while status epilepticus presented in 7(30%) patients. All included patients had acute traumatic subdural hematoma, retinal hemorrhage, and seizures in the acute period. Overall mortality was 2(9%). Logistic regression analysis identified craniotomy (p:0.01, OR:215.00; 95% CI 3.45–13408.47), SDH thickness &gt;1 cm (p:0.02, OR:68.33; 95% CI 2.15–2173.12), midline shift &gt;1 mm (p:0.03, OR:39.00; 95% CI 1.42–1067.60), and age &gt;24 months (p:0.01, OR:215.00; 95% CI 3.45–13408.47) as predictors of mortality in both univariate and multivariate analysis. Of note, 19(83%) patients had an elevated serum glucose on presentation. <h3>Conclusions:</h3> Seizures in Shaken Baby Syndrome are associated with acute traumatic subdural hematoma, and about 1 in 3 children will develop status epilepticus. Patients with craniotomy to evacuate SDH, SDH thickness &gt;1 cm, midline shift &gt;1 mm, and older age at the time of injury have a worse prognosis. <b>Disclosure:</b> Miss Stebbins has nothing to disclose. Dr. Mohammed has nothing to disclose. The institution of Dr. Shah has received research support from Eisai pharma .