Characteristics That Distinguish Accidental From Abusive Injury in Hospitalized Young Children With Head Trauma

Bechtel, Kirsten; Stoessel, Kathleen M.; Leventhal, John M.; Ogle, Eileen; Teague, Barbara; Lavietes, S.; Banyas, Bruna; Allen, K. Eileen; Dziura, James; Duncan, Charles C.

doi:10.1542/peds.114.1.165

Cited by 225 publications

(163 citation statements)

References 8 publications

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“…8 studies were comparative, including three crosssectional, [11][12][13] two comparative case series, 14,15 one prospective cohort study, 16 one case-control 17 and one retrospective cohort study. 18 The remainder were case reports 5,6,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] or case series, 3,7, concerning AHT alone, 3,[19][20][21][22][23][25][26][27][28][29][30][31][33][34][35][36][37][...…”

Section: Resultsmentioning

confidence: 99%

“…Data were interpreted in three data sets: Data set 1: Larger studies with consecutive cases presented-suitable for prevalence analysis and homogenous comparative studies entered into a metaanalysis. 11,12,14,15,17,18,47,56,61,64,66 (Vinchon raw data set)13, 16,67 Data set 2: Highly selected case series/studies with o10 subjects each. 3,[5][6][7][48][49][50][51][52][53][54][55][57][58][59][60]62,63,65,68 Data set 3: Both of the above data sets combined.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 363 children with AHT, 78% (283) had RH vs 5% (25/465) of children with nAHT. Six studies recorded the laterality of RH in AHT 11,12,17,18,56,61 and four in nAHT. 11,14,18,66 Of these, 83% (141/170) of AHT cases had bilateral RH vs 8% (1/12) case of nAHT, 11 this latter case was an 8-month old who had 10 RH per eye following a fall from a bed onto a linoleum floor.…”

Section: Retinal Findingsmentioning

confidence: 99%

“…Four studies mentioned the number of RH in AHT 11,12,18,61 and three in nAHT. 11,14,66 As terminology varied, we took the following terms to indicate 'larger' numbers of RH present: multiple, diffuse, extensive, numerous, 'too numerous to count', marked, massive, extended, scattered, many, and severe.…”

Section: Retinal Findingsmentioning

confidence: 99%

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Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

Maguire

Watts

Shaw

et al. 2012

Eye

159

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Aim To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT). Methods A systematic review of literature, 1950-2009, was conducted with standardised critical appraisal. Inclusion criteria were a strict confirmation of the aetiology, children aged o11 years and details of an examination conducted by an ophthalmologist. Post mortem data, organic disease of eye, and inadequate examinations were excluded. A multivariate logistic regression analysis was conducted to determine odds ratios (OR) and probabilities for AHT. Results Of the 62 included studies, 13 provided prevalence data (998 children, 504 AHT). Overall, retinal haemorrhages (RH) were found in 78% of AHT vs 5% of nAHT. In a child with head trauma and RH, the OR that this is AHT is 14.7 (95% confidence intervals 6.39, 33.62) and the probability of abuse is 91%. Where recorded, RH were bilateral in 83% of AHT compared with 8.3% in nAHT. RH were numerous in AHT, and few in nAHT located in the posterior pole, with only 10% extending to periphery. True prevalence of additional features, for example, retinal folds, could not be determined. Conclusions Our systematic review confirms that although certain patterns of RH were far commoner in AHT, namely large numbers of RH in both the eyes, present in all layers of the retina, and extension into the periphery, there was no retinal sign that was unique to abusive injury. RH are rare in accidental trauma and, when present, are predominantly unilateral, few in number and in the posterior pole.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Retinal Findingsmentioning

confidence: 99%

Section: Retinal Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

Maguire

Watts

Shaw

et al. 2012

Eye

159

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“…[67][68][69][70] The prevalence of abuse in young children with head injury was also high, ranging from 14% to 70% depending on the age of the child, the type and severity of head injury and the measurement of physical abuse. [71][72][73][74][75][76] …”

Section: Review Resultsmentioning

confidence: 99%

Performance of screening tests for child physical abuse in accident and emergency departments

Woodman¹,

Pitt²,

Wentz³

et al. 2008

Health Technol Assess

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How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) Programme, part of the National Institute for HealthResearch (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in t...

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Retinal Hemorrhages in Children Following Fatal Motor Vehicle Crashes

et al. 2008

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To demonstrate the severity of ocular findings in young children who died of injuries due to motor vehicle crashes. Methods: Case series of 10 children younger than 3 years who were fatally injured in motor vehicle crashes between January 1, 1994, and December 31, 2002. All children underwent autopsy that included eye examination. All available medical and autopsy records, pathology slides and photographs, and police and traffic department reports were reviewed for each case. Results: Eight patients had retinal hemorrhages, which extended into the periphery in 13 eyes and were bilateral in 7 patients. Three patients had elevated circular retinal folds. Six patients had hemorrhages below the internal limiting membrane, but no patients had deeper splitting of the retina. Nine patients had optic nerve sheath hemorrhages. Conclusion: The association of extensive, sometimes severe, ocular hemorrhages with fatal accidental trauma, compared with previous reports of accidental trauma with no or few hemorrhages, indicates the severity of injury required to cause hemorrhages of this magnitude.

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Characteristics That Distinguish Accidental From Abusive Injury in Hospitalized Young Children With Head Trauma

Cited by 225 publications

References 8 publications

Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

Performance of screening tests for child physical abuse in accident and emergency departments

Retinal Hemorrhages in Children Following Fatal Motor Vehicle Crashes

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