Auréliane Dantin, Sofia Guernouche, Sylvie Lorthois-Ninou, Vincent Des Portes, Etienne Javouhey, Carmine Mottolese, Laurence Lion-François, Federico Di Rocco
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Medical follow-up data were collected until December 31st, 2019. The primary endpoint was the Glasgow Outcome Scale (GOS) score at the end of hospitalization: the evolution was \"favourable\" if the GOS was equal to 5, and \"unfavourable\" if the GOS was lower than 5.</p><p><strong>Results: </strong>107 children were included. The mortality rate was 10 %. There was no significant difference in the GOS score at the end of hospitalization between children with \"certain\" diagnosis and those with \"probable\" diagnosis (p = 0.75). There was no significant difference at last follow-up between these two groups. Among the children with an \"unfavourable\" outcome, 68 % had psychomotor developmental delay, 57 % had motor sequelae, 38 % had visual impairments and 36 % had epilepsy. Among those with a \"favourable\" outcome, 31 % had language disorders and 13 % had learning disorders. The GOS score at the end of follow-up was identical to the GOS at the end of hospitalization for 76 % of patients. It had improved for 14 % of the patients and had deteriorated for 10 % of the patients.</p><p><strong>Conclusions: </strong>The \"certain\" or \"probable\" diagnosis of SBS according to HAS criteria does not modify the risk of sequelae during follow-up. Mortality and morbidity remain significant. 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Medical follow-up data were collected until December 31st, 2019. The primary endpoint was the Glasgow Outcome Scale (GOS) score at the end of hospitalization: the evolution was \\\"favourable\\\" if the GOS was equal to 5, and \\\"unfavourable\\\" if the GOS was lower than 5.</p><p><strong>Results: </strong>107 children were included. The mortality rate was 10 %. There was no significant difference in the GOS score at the end of hospitalization between children with \\\"certain\\\" diagnosis and those with \\\"probable\\\" diagnosis (p = 0.75). There was no significant difference at last follow-up between these two groups. Among the children with an \\\"unfavourable\\\" outcome, 68 % had psychomotor developmental delay, 57 % had motor sequelae, 38 % had visual impairments and 36 % had epilepsy. Among those with a \\\"favourable\\\" outcome, 31 % had language disorders and 13 % had learning disorders. 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引用次数: 0
摘要
目的：摇晃婴儿综合征（SBS）诊断困难；2017年，法国卫生高级管理局（Haute autorit de sant， HAS）引入了临床和放射学标准，将诊断分为“确定”或“可能”。本研究的目的是比较具有SBS“确定”和“可能”诊断标准的儿童的临床演变。方法：回顾性分析2008年1月1日至2018年3月31日在某大学医院收治的符合HAS标准的1 ~ 16个月SBS患者的记录。医学随访数据收集至2019年12月31日。主要终点是住院结束时的格拉斯哥结局量表（GOS）评分：如果GOS等于5，则演变为“有利”，如果GOS低于5，则为“不利”。结果：共纳入107例患儿。死亡率为10%。“确定”诊断患儿与“可能”诊断患儿住院结束时GOS评分差异无统计学意义（p = 0.75）。两组在最后随访时无显著差异。在“不良”结果的儿童中，68%有精神运动发育迟缓，57%有运动后遗症，38%有视力障碍，36%有癫痫。在结果“良好”的患者中，31%有语言障碍，13%有学习障碍。随访结束时的GOS评分与76%患者住院结束时的GOS评分相同。14%的患者病情好转，10%的患者病情恶化。结论：根据HAS标准对SBS的“确定”或“可能”诊断并不能改变随访期间发生后遗症的风险。死亡率和发病率仍然很高。在这两种情况下，多学科管理和专门的医疗长期随访是必不可少的。
« Certain » and « probable » shaken baby syndrome according to the HAS diagnostic criteria: a different neurological prognosis?
Objectives: The diagnosis of shaken baby syndrome (SBS) is difficult; the French High Authority for Health called "Haute Autorité de Santé" (HAS) introduced clinical and radiological criteria in 2017 to classify the diagnosis as "certain" or "probable." The aim of this study is to compare the clinical evolution of children with "certain" and "probable" diagnosis criteria of SBS.
Methods: Records of patients with a diagnosis of SBS according to HAS criteria, aged 1 to 16 months, admitted to a University Hospital between January 1st, 2008, and March 31st, 2018, were retrospectively analysed. Medical follow-up data were collected until December 31st, 2019. The primary endpoint was the Glasgow Outcome Scale (GOS) score at the end of hospitalization: the evolution was "favourable" if the GOS was equal to 5, and "unfavourable" if the GOS was lower than 5.
Results: 107 children were included. The mortality rate was 10 %. There was no significant difference in the GOS score at the end of hospitalization between children with "certain" diagnosis and those with "probable" diagnosis (p = 0.75). There was no significant difference at last follow-up between these two groups. Among the children with an "unfavourable" outcome, 68 % had psychomotor developmental delay, 57 % had motor sequelae, 38 % had visual impairments and 36 % had epilepsy. Among those with a "favourable" outcome, 31 % had language disorders and 13 % had learning disorders. The GOS score at the end of follow-up was identical to the GOS at the end of hospitalization for 76 % of patients. It had improved for 14 % of the patients and had deteriorated for 10 % of the patients.
Conclusions: The "certain" or "probable" diagnosis of SBS according to HAS criteria does not modify the risk of sequelae during follow-up. Mortality and morbidity remain significant. Multidisciplinary management and specialized medical long-term follow-up are essential in both conditions.
期刊介绍：
Archives de Pédiatrie publishes in English original Research papers, Review articles, Short communications, Practice guidelines, Editorials and Letters in all fields relevant to pediatrics.
Eight issues of Archives de Pédiatrie are released annually, as well as supplementary and special editions to complete these regular issues.
All manuscripts submitted to the journal are subjected to peer review by international experts, and must:
Be written in excellent English, clear and easy to understand, precise and concise;
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Under no circumstances does the journal guarantee publication before the editorial board makes its final decision.
Archives de Pédiatrie is the official publication of the French Society of Pediatrics.
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