Dedicated Retinal Examination in Children Evaluated for Physical Abuse without Radiographically Identified Traumatic Brain Injury

Greiner, Mary V.; Berger, Rachel P.; Thackeray, Jonathan D.; Lindberg, Daniel M.

doi:10.1016/j.jpeds.2013.01.063

Cited by 24 publications

(17 citation statements)

References 20 publications

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“…13 The review raises the possibility of subconjunctival haemorrhages as a 'sentinel injury' in child maltreatment, as has previously been described for bruising or a torn labial frenum. [14][15][16] The identification of 'sentinel injuries' in children who later suffer severe physical maltreatment has become increasingly appreciated in recent years. 15 These are minor injuries such as bruising or intraoral injury in precruising children, which are clearly visible to caregiver or medical practitioner and poorly explained or unexpected.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] The identification of 'sentinel injuries' in children who later suffer severe physical maltreatment has become increasingly appreciated in recent years. 15 These are minor injuries such as bruising or intraoral injury in precruising children, which are clearly visible to caregiver or medical practitioner and poorly explained or unexpected. In 2013 Sheets et al published a retrospective case-control study evaluating the incidence of such injuries in abused and non-abused children.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of non-vitreoretinal ocular injury in child maltreatment: a systematic review

Betts

Ahmed

Maguire

et al. 2017

Eye

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explicit confirmation of injury aetiology, age <18 years, examination conducted by an ophthalmologist. Exclusion: post-mortem data, organic diseases, review articles. Standardised critical appraisal and narrative synthesis was conducted of included publications by two independent reviewers.ResultsOf 1492 studies identified, 153 full texts were assessed, 49 underwent full review, resulting in five included studies: three case series and two case reports. The 26 included cases describe a wide variety of ocular, facial and skeletal injuries occurring as a consequence of child maltreatment. Ocular signs included periorbital oedema, chemosis, injection, abrasion, hyphaema, and cataract. Of interest all children that had suffered physical abuse with ocular injury had subconjunctival haemorrhages. Children presenting with abusive ocular injuries had a mean age of 13.9 months (range 1-68), while those who suffered violent corporal punishment were considerably older (mean 96 months). All cases, apart from severe corporal punishment, underwent screening for occult fractures, but neuroimaging only apparent in 2/5 eligible cases.ConclusionAlthough, the face is the most common site of abusive injury, there is a paucity of high-quality data on non-vitreoretinal ocular abusive injury. Thus, while subconjunctival haemorrhages are a potential sentinel injury of maltreatment, and may warrant further evaluation, the lack of large-scale published data limits our ability to highlight further specific characteristics of non-vitreoretinal ocular injury indicative of child abuse.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics of non-vitreoretinal ocular injury in child maltreatment: a systematic review

Betts

Ahmed

Maguire

et al. 2017

Eye

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“…[6][7][8] Several diagnostic studies (eg, skeletal survey [SS], neuroimaging, hepatic transaminases, and retinal examination) can identify occult abusive injuries and improve abuse recognition and diagnosis. [9][10][11][12][13][14][15] However, use of these studies has been shown to be widely variable, and to be affected by practice setting, race, and socioeconomic status. 16,17 Twice as many children with highrisk injuries are recognized as abused in children's hospitals than in general hospitals, 18 and abusive fractures are 7 times more likely to be missed in general emergency departments (EDs) than in pediatric EDs.…”

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confidence: 99%

Testing for Abuse in Children With Sentinel Injuries

Lindberg¹,

et al. 2015

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OBJECTIVE: Child physical abuse is commonly missed, putting abused children at risk for repeated injury and death. Several so-called sentinel injuries have been suggested to be associated with high rates of abuse, and to imply the need for routine testing for other, occult traumatic injuries. Our objective was to determine rates of abuse evaluation and diagnosis among children evaluated at leading children's hospitals with these putative sentinel injuries.METHODS: This is a retrospective secondary analysis of the Pediatric Health Information System database. We identified 30 355 children with putative sentinel injuries. We measured rates of abuse diagnosis and rates of testing commonly used to identify occult injuries.RESULTS: Among all visits for children ,24 months old to Pediatric Health Information System hospitals, the rate of abuse diagnosis was 0.17%. Rates of abuse diagnosis for children with at least 1 putative sentinel injury ranged from 3.5% for children ,12 months old with burns to 56.1% for children ,24 months with rib fractures. Rates of skeletal survey and other testing that can identify occult traumatic injury were highly variable between centers and for different injuries.CONCLUSIONS: Several putative sentinel injuries are associated with high rates of physical abuse. Among eligible children with rib fracture(s), abdominal trauma, or intracranial hemorrhage, rates of abuse were more than 20%. Future work is warranted to test whether routine testing for abuse in these children can improve early recognition of abuse.

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“…Furthermore, in the absence of neuroimaging findings, recent evidence by Greiner et al [20] supports deferral of dedicated retinal exam. The radiology and ophthalmology literature relating to the diagnosis of AHT continues to grow.…”

Section: Diagnostic Work-upmentioning

confidence: 98%