Risk factors associated with retinal hemorrhage in suspected abusive head trauma

Abstract

PurposeTo determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects.MethodsRecords of children aged 0–3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case–control study. Children were classified into case and control groups based on RH presence. Medical history, presenting symptoms, reasons, and characteristics of injury were recorded. Logistic regression analysis was performed to identify risk factors.ResultsA total of 168 children (104 males) were included. Of these, 103 were classified as cases and 65 as controls. The mean age (with standard deviation) was 9.3 ± 8.3 months (range, 1 day-36 months). Of the 103 cases, 22 (21%) had subretinal hemorrhage, 9 (9%) had retinoschisis, and 1 (1%) had vitreous hemorrhage. Children presenting with lethargy or altered mental status (P < 0.0001), subdural hemorrhage (P < 0.0001), and other radiologic findings (eg, cerebral ischemia, diffuse axonal injury, hydrocephalus, or solid organ injury; P = 0.01546) were likely to have RH. All 23 children with skull or nonskull fracture without intracranial hemorrhage did not have RH (P < 0.0001 both categories).ConclusionsRetinal hemorrhages were almost never found in the absence of intracranial hemorrhage and not found in the setting of fracture without intracranial hemorrhage.

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective

“…In 2010, Thackeray et al [ 62 ] showed that among 282 children with no evidence of TBI on neuroimaging, only two (0.7%; 95% CI, 0.1–2.5) children had RH. In another study by Burkhart et al [ 7 ], the results were similar as follows: among the 168 children enrolled, 23 children (13.7%) were found to have skull or nonskull fracture without intracranial hemorrhage, and among these children, no RH was found. These findings indicate that an RH evaluation is only indicated in the presence of intracranial injury [ 7 ].…”

Predictive value of non‐ocular findings for retinal haemorrhage in children evaluated for non‐accidental trauma

“…By contrast, Burkhart et al. (2015) did not find that skull fractures were statistically significant predictors of RH in children ages 0–3 years. Contrary to the suggestion by Li et al.…”

“…In fact, the variables with the strongest evidence for association with RH in our study were mSDH, GCS < 15 and occipital lobe injury. Our study also included more specific physical examination and imaging variables compared to that of Burkhart et al (2015), in addition to examining a wider age range and having a larger overall sample size. This allows the results of our study to extend to patients older than 3 years old and provides greater confidence in making clinical decisions based on findings such as long bone fractures or truncal lacerations, which the study by Burkhart et al (2015) did not directly address.…”

“…Our study also included more specific physical examination and imaging variables compared to that of Burkhart et al (2015), in addition to examining a wider age range and having a larger overall sample size. This allows the results of our study to extend to patients older than 3 years old and provides greater confidence in making clinical decisions based on findings such as long bone fractures or truncal lacerations, which the study by Burkhart et al (2015) did not directly address. Finally, we present novel insight into the relationship between external ocular or anterior segment findings and RH, as well as the rates and outcomes of ophthalmologic follow-up at a level I trauma centre in upstate New York.…”

The Anesthesiologist’s Role in Treating Abusive Head Trauma

“…12 The reported incidence of retinal hemorrhage in AHT varies from 30% to more than 80%. 13–16 The acute-on-chronic nature of AHT results in both acute and chronic subdural hematomas, and the repeated abuse itself can cause acute subdural hemorrhages rather than hemorrhages from spontaneous re-bleeding. Children with acute and chronic subdural hemorrhages from AHT may present with asymptomatic macrocephaly, although more severe acute intracranial hemorrhages will cause acute neurologic symptoms.…”