Rare retinal haemorrhages in translational accidental head trauma in children

Sturm, Volker; Knecht, Pascal B.; Landau, Klara; Menke, Marcel N.

doi:10.1038/eye.2008.317

Cited by 16 publications

(5 citation statements)

References 28 publications

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“…Multiple clinical and postmortem studies of eyes in patients with severe accidental head injury suggest that the rate of retinal hemorrhage is less than 4%, and in most studies the incidence is zero, particularly when the injury is due to a short fall [8,9,16,25]. When retinal hemorrhages occur following accidental injury, the injury history is usually unambiguous and consistent (e.g., motor vehicle accident, witnessed very high fall), the clinical condition is life-threatening, other injuries match the traumatic forces, and the infants have no additional unexplained injuries.…”

Section: Differential Diagnosismentioning

confidence: 98%

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

Binenbaum

Forbes

2014

Pediatr Radiol

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This review presents an up-to-date overview of ocular injuries resulting from child abuse, with a spotlight on abusive head trauma. Retinal hemorrhage is a principle finding of inflicted head trauma. The specific pattern of hemorrhages holds valuable diagnostic information, which can help to guide multidisciplinary assessments of the likelihood of abuse. Indirect ophthalmoscopy through dilated pupils by an ophthalmologist is necessary for adequate examination and documentation of retinal findings. Initial pediatrician evaluation of the eye and indications for ophthalmological consultation are reviewed. Focus is then placed upon understanding retinal hemorrhage patterns, their diagnostic significance and likely pathophysiological mechanisms. The differential diagnosis of retinal hemorrhage in young children is discussed, highlighting key distinctions among retinal hemorrhage patterns, severity and frequencies, as well as other ocular findings. The most common cause of retinal hemorrhage in an infant is trauma, and most other causes can be identified by considering the hemorrhage pattern, ocular or systemic signs and the results of laboratory and imaging tests, when indicated.

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Section: Differential Diagnosismentioning

confidence: 98%

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

Binenbaum

Forbes

2014

Pediatr Radiol

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“…In addition, the term retinal hemorrhages has been used indiscriminately by many physicians and investigators to describe a spectrum of findings. When bilateral, numerous, extensive in location, and of multiple types, retinal hemorrhages are highly suggestive of abuse 6,8,10,12. However, retinal hemorrhages may also be unilateral and few in number and type in cases of abusive head trauma.…”

Section: Introductionmentioning

confidence: 99%

Odds of abuse associated with retinal hemorrhages in children suspected of child abuse

Binenbaum

Mirza-George

Christian

et al. 2009

Journal of American Association for Pediatric Ophthalmology and

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Purpose-To describe the prevalence of retinal hemorrhages in children being evaluated for abusive head trauma and quantify the association between the likelihood of abuse and the presence and severity of retinal hemorrhages.Methods-Retrospective cross-sectional study of 110 children aged 15 months or younger who were evaluated for abusive head trauma and received an ophthalmological examination. The child abuse specialist's diagnosis was categorized as definite accident, probable accident, probable abuse, or definite abuse, according to an algorithm that excluded eye findings. Retinal hemorrhage severity was scored on a 12-point scale (6 points per eye) based on type, size, location, and extent. Higher scores indicated greater severity of eye findings.Results-Seventy-four percent of children were under 6 months old. Forty-five percent of cases were definite-abuse and 37% were definite-accident. The prevalence of retinal hemorrhages was 32%. Across all subjects, the presence of retinal hemorrhage was highly associated with definite or probable abuse versus definite or probable accident (age-adjusted odds ratio 5.4 [95% CI, 2.1-13.6]). The odds ratio in children under age 6 months (n = 81) was 11.7 (95% CI, 2.9-66.8). Retinal hemorrhage severity was higher in abuse versus accident (p < 0.0001) and correlated positively with abuse (Spearman r = 0.406, p < 0.0001). Scores above 8 (n = 13) were only present in abused children Conclusions-Retinal hemorrhages are highly associated with abusive head trauma, particularly in children under age 6 months. Increasing retinal hemorrhage severity is correlated with increasing likelihood of abuse.

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“…In addition, traumatic retinoschisis and perimacular folds are also caused by traction at the macula. Ocular coherence tomography studies have supported this mechanism [34,35]. The preponderance of retinal hemorrhage in the retinal periphery is another manifestation of vitreoretinal traction.…”

Section: Pathogenesis Of Ocular Findingsmentioning

confidence: 90%

Pathology of retinal hemorrhage in abusive head trauma

Wygnanski–Jaffe

Morad

Levin

2009

Forensic Sci Med Pathol

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Abusive head injury, characterized by repeated acceleration-deceleration forces, is associated with retinal hemorrhages as demonstrated in many clinical and postmortem studies. The theory that vitreoretinal traction is the major factor in the pathogenesis of retinal hemorrhages is presently the most widely accepted explanation based on different lines of research. Postmortem examination of the eye and orbital structures is essential for recognizing abusive head injury and also for identifying other possible medical conditions which can cause retinal hemorrhage.

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Rare retinal haemorrhages in translational accidental head trauma in children

Cited by 16 publications

References 28 publications

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

Odds of abuse associated with retinal hemorrhages in children suspected of child abuse

Pathology of retinal hemorrhage in abusive head trauma

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