Retinal haemorrhages in- head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age

Trenchs, Victoria; Curcoy, Ana Isabel; Morales, Michele; Serra, Alicia; Navarro, Ramón; Pou, Jordi

doi:10.1007/s00381-008-0583-y

Cited by 26 publications

(16 citation statements)

References 23 publications

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“…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%

“…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: 96%

“…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. Terms taken to represent 'smaller' numbers were: 'single haemorrhage', few and small.…”

Section: Retinal Findingsmentioning

confidence: 99%

“…The distribution of RH (eg, did they extend to the periphery), was only recorded in seven AHT 11,18,56,61 (Vinchon raw data set)13,16,67 and seven nAHT 11,14,18,66 (Vinchon raw data set)13,16,67 studies. The majority of AHT cases, 63%, (101/160) had peripheral extension of RH, while only 9% (2/22) of nAHT cases had.…”

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

158

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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: Retinal Findingsmentioning

confidence: 96%

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

158

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“…This was a strong supplemental argument for AHT since retinal hemorrhages have been considered in previous reports as specific signs of abuse from a shaking mechanism when associated with SDH in neonates and toddlers without a clear history of trauma. 1,[8][9][10][12][13][14]16,19,22,[24][25][26]29 SDH is the most common finding on cranial CT scans of patients who are victims of AHT (present in > 70% of cases); 2,3,7,8,23 it is commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages 3,7,8,30 as we found in our sample. The SDHs in our patients were sometimes exclusively hyperdense (acute) or heterogeneous (acute and subacute), due to the natural sedimentation, accumulation of CSF and hemoglobin oxidation in different stages, or were homogeneously hypodense as described by some authors.…”

Section: Discussionmentioning

confidence: 63%

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

Melo

Rocco²,

Bourgeois³

et al. 2014

PED

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Object Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols. The authors report their experience and discuss the routine surgical options in the management of traumatic SDH at a Level 1 Pediatric Trauma Center. Methods In this paper, the authors describe a cross-sectional study with consecutive revision of data described in the medical records of Hôpital Universitaire Necker–Enfants Malades between January 2008 and January 2013. During this period, all children younger than 2 years of age who were admitted with a traumatic SDH identified on CT scans were included in this study. Results One hundred eighty-four children who had SDH and were younger than 2 years of age were included. Their median age was 5.8 months (range 5 days–23 months), and 70% of the children were male. On admission CT scans, the SDH was bilateral in 52% of cases and homogeneously hypodense in 77%. Neurosurgical treatment was undertaken in 111 children (60%) with an admission Glasgow Coma Scale score of 12 or less, bulging fontanels, or other signs suggestive of intracranial hypertension. The first surgical option was craniotomy in 1.8% (2) of these 111 cases, decompressive craniectomy in 1.8% (2), transcutaneous subdural puncture in 15% (17), external subdural drainage in 16% (18), subdural-subgaleal shunt placement in 17% (19), and subdural-peritoneal shunt placement in 48% (53). In 82% of the children initially treated with transcutaneous subdural puncture and in 50% of those treated with external subdural drainage, increase or persistence of the SDH, CSF or skin infection, or shunt system malfunction was observed and further surgical intervention was required. There was a 26% rate of complications in patients initially treated with a subdural-peritoneal shunt. Although 52% of the patients had bilateral SDH, bilateral drainage was only required in 9.4%. Conclusions The choice of treatment should be determined by the clinical and radiological characteristics of the individual case. Although effective on an emergency basis, subdural puncture and external subdural drainage are frequently insufficient to obtain complete resolution of SDH, and temporary placement of a subdural-peritoneal shunt is needed in most cases.

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Critical Care

Holzman¹,

Mancuso²,

Sethna³

et al. 2010

Pediatric Anesthesiology Review

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Retinal haemorrhages in- head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age

Cited by 26 publications

References 23 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

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

Critical Care

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