Nonophthalmologist accuracy in diagnosing retinal hemorrhages in the shaken baby syndrome

Morad, Yair; Kim, Yuri M.; Mian, Marcellina; Huyer, Dirk; Capra, Louise; Levin, Alex V.

doi:10.1067/mpd.2003.161

Cited by 54 publications

(29 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…50 In a third case, 7 days after an initial negative CT and MRI, repeated MRI showed SDH. 69(Case 7) No repeat CT or MRI was performed in 5/9 25, 69(Cases 1,5,6,8) but in one case three MRI scans (performed for 24 h, 7 days, 6 months) were normal, 69(Case 3) despite presenting with seizures, lethargy, and irregular breathing.…”

Section: Coexistent Intracranial Features In Children With Rhmentioning

confidence: 99%

“…Our highest rank was an examination conducted by an ophthalmologist, using indirect ophthalmoscopy and pupillary dilatation ( þ / À additional retinal imaging), with detailed recording of the retinal findings relating to RH (laterality, layers of retina involved, number and extent (from optic disc to peripheral retina) of haemorrhages) and additional features (eg, retinoschisis). Our minimum accepted standard was an examination by an ophthalmologist, as it is well-recognised that nonophthalmologists may miss RH 8 and additional findings are unlikely to have been documented in detail. We also wished to determine any correlation between specific intracranial findings and retinal findings.…”

Section: Quality Standardsmentioning

confidence: 99%

See 1 more Smart Citation

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

Maguire

Watts

Shaw

et al. 2012

Eye

159

View full text Add to dashboard Cite

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.

show abstract

Section: Coexistent Intracranial Features In Children With Rhmentioning

confidence: 99%

Section: Quality Standardsmentioning

confidence: 99%

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

Maguire

Watts

Shaw

et al. 2012

Eye

159

View full text Add to dashboard Cite

show abstract

“…Children under two years of age with suspected AHT should have a fundoscopic examination, preferably by an ophthalmologist, to identify retinal hemorrhages and other eye injuries. Non-ophthalmologists may have difficulty performing an adequate examination and thereby fail to identify injuries that, although not pathognomonic, suggest inflicted injury (22). To accomplish this, every MDT should have an ophthalmologist involved in the team.…”

Section: Discussionmentioning

confidence: 99%

Abusive Head Trauma in Turkey and Impact of Multidisciplinary Team Establishment Efforts on Case Finding and Management: Preliminary Findings

Yaylacı¹,

Dallar²,

Sayar³

et al. 2016

EAJEM

View full text Add to dashboard Cite

Aim: Abusive head trauma (AHT) is the most common cause of death as the result of child abuse. A task force is planned to provide training on AHT to professionals in different disciplines on clinical presentation, diagnostic workup, and organization of multidisciplinary evaluation at the hospital and community levels. This study reports on the preliminary findings of the pre-intervention phase of a larger study. Materials and Methods:This is a descriptive, retrospective study exploring the rates of documentation of relevant data in charts, including risk factors for abuse, family demographics, completeness of diagnostic workup, and case finding.Results: Overall, 345 cases were found in hospital databases that were eligible for the retrospective study from 10 participating hospitals. In total, 305 cases (88.4%) were younger than 2 years of age. The most common documented risk factors were low parental education level in 82 families (23.8%), more than three children under 7 years of age in 76 families (22.0%), and bad child temper in 16 families (4.6%), among others. The rate of complete diagnostic workup in hospitals with a multidisciplinary team (MDT) (25.7%) was statistically significantly higher than in hospitals without an MDT (2.9%) (p=0.001). Etiology was identified as inflicted in 78 cases (22.6%), possibly inflicted in 24 (7.0%), undetermined in 79 (22.9%), and accidental in 164 (47.5%) by the researchers, compared to only three cases (0.8%) diagnosed as inflicted by the treating physicians (p<0.0001). In two of the three cases, the perpetrator was convicted; in one, the prosecutor closed the case without a trial on the basis of "no confession" despite the death of the child and medical evidence. Conclusion:Clinicians' knowledge of the diagnosis of AHT should be increased to improve case finding, which will allow determination of more accurate incidence/prevalence. This can be accomplished via the establishment of an MDT in teaching hospitals as well as staff training on how to recognize suspicious cases, how to utilize MDT services, and how to report and manage cases on a community level multidisciplinary basis. (Eurasian J Emerg Med 2016; 15: 24-9)

show abstract

“…It seems that vitreoretinal traction and orbital injury sustained during the unique repetitive accelerationdeceleration mechanism that distinguishes this form of abuse from singleimpact trauma is the critical factor in causing retinal hemorrhage. 8 Factors such as hypoxia, anemia, and intracranial pressure may play important secondary roles in modulating the appearance of retinal hemorrhages but do not, in and of themselves, result in such a retinopathy. 6 Further research is needed to better define the role of these and other factors as our understanding of the pathophysiology and diagnostic specificity of retinal hemorrhage continues to evolve.…”

Section: Statement Of the Problemmentioning

confidence: 99%

“…Although health care professionals other than ophthalmologists may be skilled at detecting the absence or presence of retinal hemorrhage, 8 a full view of the retina and characterization of the number, types, and patterns of the hemorrhages requires consultation by an opthalmologist using indirect ophthalmoscopy, preferably with a dilated pupil. Even when there may be a concern about transiently obliterating pupillary reactivity in the face of a need to monitor neurologic status acutely, techniques such as dilation of 1 eye at a time, use of short-acting mydriatics, and use of a lens that affords some view through an undilated pupil can be employed to allow indirect ophthalmoscopy, preferably within the first 24 hours and ideally within 72 hours after the child's acute presentation.…”

mentioning

confidence: 99%

The Eye Examination in the Evaluation of Child Abuse

Christian¹,

Levin²,

Neglect³

2010

Pediatrics

Self Cite

View full text Add to dashboard Cite

Retinal hemorrhage is an important indicator of possible abusive head trauma, but it is also found in a number of other conditions. Distinguishing the type, number, and pattern of retinal hemorrhages may be helpful in establishing a differential diagnosis. Identification of ocular abnormalities requires a full retinal examination by an ophthalmologist using indirect ophthalmoscopy through a pupil that has been pharmacologically dilated. At autopsy, removal of the eyes and orbital tissues may also reveal abnormalities not discovered before death. In previously well young children who experience unexpected apparent life-threatening events with no obvious cause, children with head trauma that results in significant intracranial hemorrhage and brain injury, victims of abusive head trauma, and children with unexplained death, premortem clinical eye examination and postmortem examination of the eyes and orbits may be helpful in detecting abnormalities that can help establish the underlying etiology.

show abstract

Nonophthalmologist accuracy in diagnosing retinal hemorrhages in the shaken baby syndrome

Cited by 54 publications

References 5 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

Abusive Head Trauma in Turkey and Impact of Multidisciplinary Team Establishment Efforts on Case Finding and Management: Preliminary Findings

The Eye Examination in the Evaluation of Child Abuse

Contact Info

Product

Resources

About