Apnoea and brain swelling in non-accidental head injury * COMMENTARY

Kemp, Alison; Stoodley, Neil; Cobley, Cathy; Coles, Lisa D.; Kemp, Kenneth W.

doi:10.1136/adc.88.6.472

Cited by 122 publications

(66 citation statements)

References 36 publications

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“…Investigators have long suggested a model in which the neuronal injury resulting from hypoxia results in sleep apneaassociated cognitive impairment [68]. Hypoxic damage resulting from a broad range of disorders (e.g., brain injury, stroke, cardiac arrest) is well documented to negatively affect function and cognition, although the literature on the relationship between sleep apnea-related measures of hypoxia, such as minimum or average level of oxygen desaturation, and cognitive function is quite limited and the findings mixed [50,[69][70][71]. In our own clinical investigation, we found that although average minimum level of arterial oxygen saturation (MinSaO 2 ) displayed a nonsignificant tendency to negatively interact with the APOE ε4 allele to affect memory, the actual number of respiratory events was most strongly associated with impaired cognition [50].…”

Section: Sleep Apnea Tbi and Apoe ε4 Allelementioning

confidence: 99%

Sleep apnea, apolipoprotein epsilon 4 allele, and TBI: Mechanism for cognitive dysfunction and development of dementia

O’Hara¹,

Luzon²,

Hubbard³

et al. 2009

JRRD

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Abstract-Sleep apnea is prevalent among patients with traumatic brain injuries (TBIs), and initial studies suggest it is associated with cognitive impairments in these patients. Recent studies found that the apolipoprotein epsilon 4 (APOE epsilon 4) allele increases the risk for sleep disordered breathing, particularly sleep apnea. The APOE epsilon 4 allele is associated with cognitive decline and the development of dementia in the general population as well as in patients with TBI. These findings raise the question of whether patients with TBI who are APOE epsilon 4 allele carriers are more vulnerable to the negative effects of sleep apnea on their cognitive functioning. While few treatments are available for cognitive impairment, highly effective treatments are available for sleep apnea. Here we review these different lines of evidence, making a case that the interactive effects of sleep apnea and the APOE epsilon 4 allele represent an important mechanism by which patients with TBI may develop a range of cognitive and neurobehavioral impairments. Increased understanding of the relationships among sleep apnea, the APOE epsilon 4 allele, and cognition could improve our ability to ameliorate one significant source of cognitive impairment and risk for dementia associated with TBI.

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Section: Sleep Apnea Tbi and Apoe ε4 Allelementioning

confidence: 99%

Sleep apnea, apolipoprotein epsilon 4 allele, and TBI: Mechanism for cognitive dysfunction and development of dementia

O’Hara¹,

Luzon²,

Hubbard³

et al. 2009

JRRD

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show abstract

“…8,41 This is attributable in part to the different mechanism of injury in inflicted TBI, the extent of axonal injury, and the frequent presence of hypoxic ischemic injury. 42,43 Children who have sustained nonneurologic physical abuse would not be suitable control subjects as they score significantly lower in cognitive, motor, and social skills in comparison with control subjects, and the occurrence of a previous neurologic insult cannot be ruled out. 44 The postinjury environment is likely to influence outcome and is difficult to control for.…”

Section: Methodologic Issuesmentioning

confidence: 99%

Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy

Barlow

Thomson

Johnson³

et al. 2005

Pediatrics

301

175

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ABSTRACT.Objective. There is limited information regarding the long-term outcome of inflicted traumatic brain injury (TBI), including shaken infant syndrome. The purpose of this study was to describe the long-term neurologic, behavioral, and cognitive sequelae seen in this population.Methods. A cross-sectional and prospective longitudinal study was conducted of 25 children with inflicted TBI in Scotland between 1980 and 1999. After consent was obtained, neurologic and cognitive examinations were performed on all participants and sequentially in the prospective cohort. Two global outcome measures were used: Glasgow Outcome Score (GOS) and Seshia's outcome score. Cognitive outcome was assessed using the Bayley Scales of Infant Development, British Ability Scales, and the Vineland Adaptive Behavior Scales.Results. The mean length of follow-up was 59 months. A total of 68% of survivors were abnormal on follow-up, 36% had severe difficulties and were totally dependant, 16% had moderate difficulties, and 16% had mild difficulties on follow-up. A wide range of neurologic sequelae were seen, including motor deficits (60%), visual deficits (48%), epilepsy (20%), speech and language abnormalities (64%), and behavioral problems (52%). There was a wide range of cognitive abilities: the mean psychomotor index, 69.9 (SD: ؎25.

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“…Our original tool was derived from a rigorous systematic review of world literature. 18 Thanks to the generous sharing of original data on 6 key clinical features from the highestquality publications, [24][25][26][27][28][29] we developed a tool to predict AHT, using a data set of 1053 cases of children with intracranial injury (ICI). 30 We refer to this as the PredAHT tool.…”

mentioning

confidence: 99%

Validation of a Prediction Tool for Abusive Head Trauma

et al. 2015

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BACKGROUND AND OBJECTIVES: Abusive head trauma (AHT) may be missed in the clinical setting. Clinical prediction tools are used to reduce variability in practice and inform decision-making. From a systematic review and individual patient data analysis we derived the Predicting Abusive Head Trauma (PredAHT) tool, using multilevel logistic regression to predict likelihood of AHT. This study aims to externally validate the PredAHT tool.METHODS: Consecutive children aged ,36 months admitted with an intracranial injury, confirmed as abusive or nonabusive, to 2 sites used in the original model were ascertained. Details of 6 influential features were recorded (retinal hemorrhage, rib and long -bone fractures, apnea, seizures, and head or neck bruising). We estimated the likelihood of an unrecorded feature being present with multiple imputation; analysis included sensitivity, specificity, and area under the curve, with 95% confidence intervals (CIs).RESULTS: Data included 133 non-AHT cases and 65 AHT cases, 97% of children were ,24 months old. Consistent with original predictions, when $3 features were present in a child ,36 months old with intracranial injury, the estimated probability of AHT was .81.5% (95% CI, 63.3-91.8). The sensitivity of the tool was 72.3% (95% CI, 60.4-81.7), the specificity was 85.7% (95% CI, 78.8-90.7), area under the curve 0.88 (95% CI, 0.823-0.926).CONCLUSIONS: When tested on novel data, the PredAHT tool performed well. This tool has the potential to contribute to decision-making in these challenging cases. An implementation study is needed to explore its performance and utility within the child protection process. WHAT'S KNOWN ON THIS SUBJECT:A previous multivariable statistical model, using individual patient data, estimated the probability of abusive head trauma based on the presence or absence of 6 clinical features: rib fracture, long-bone fracture, apnea, seizures, retinal hemorrhage, and head or neck bruising. WHAT THIS STUDY ADDS:The model performed well in this validation, with a sensitivity of 72.3%, specificity of 85.7%, and area under the curve of 0.88. In children ,3 years old with intracranial injury plus $3 features, the estimated probability of abuse is .81.5%. Ms Cowley drafted the Methods section, produced the tables, revised the article, formatted the article, and contributed to overall editing; Dr Morris collected the data in data set 1 and entered all anonymized data into the database; Dr. Maguire had the initial study idea, drafted and revised the article, and contributed to the study design and overall editing; Dr Farewell designed and conducted all statistical analyses, drafted the statistical components of the article, produced the figures, and contributed to overall editing; Prof Kemp revised the article and contributed to overall study design and editing; and all authors approved the final manuscript as submitted. Clinicians who undertake child protection investigations of children presenting with head injury can meet resistance and face a barrage of critici...

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Apnoea and brain swelling in non-accidental head injury * COMMENTARY

Cited by 122 publications

References 36 publications

Sleep apnea, apolipoprotein epsilon 4 allele, and TBI: Mechanism for cognitive dysfunction and development of dementia

Sleep apnea, apolipoprotein epsilon 4 allele, and TBI: Mechanism for cognitive dysfunction and development of dementia

Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy

Validation of a Prediction Tool for Abusive Head Trauma

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