Retinal Hemorrhages in Low-Risk Children Evaluated for Physical Abuse

Li, Simiao; Mitchell, Ellen; Fromkin, Janet; Berger, Rachel P.

doi:10.1001/archpediatrics.2011.150

Cited by 14 publications

(15 citation statements)

References 22 publications

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“…Thackery and colleagues found that out of 282 children without traumatic brain injury, only 2 had retinal hemorrhages that were consistent with abuse. 18 Li and colleauges 22 found no RHs in patients presenting with what the authors described as “low-risk criteria,” that is, no intracranial injury, normal mental state, and no bruising to the face or head. Additionally, Griener and colleagues 23 also found only 2 children with RH out of 352 with no traumatic brain injury.…”

Section: Discussionmentioning

confidence: 98%

Risk factors associated with retinal hemorrhage in suspected abusive head trauma

Burkhart

Thurber²,

Chuang³

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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PurposeTo determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects.MethodsRecords of children aged 0–3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case–control study. Children were classified into case and control groups based on RH presence. Medical history, presenting symptoms, reasons, and characteristics of injury were recorded. Logistic regression analysis was performed to identify risk factors.ResultsA total of 168 children (104 males) were included. Of these, 103 were classified as cases and 65 as controls. The mean age (with standard deviation) was 9.3 ± 8.3 months (range, 1 day-36 months). Of the 103 cases, 22 (21%) had subretinal hemorrhage, 9 (9%) had retinoschisis, and 1 (1%) had vitreous hemorrhage. Children presenting with lethargy or altered mental status (P < 0.0001), subdural hemorrhage (P < 0.0001), and other radiologic findings (eg, cerebral ischemia, diffuse axonal injury, hydrocephalus, or solid organ injury; P = 0.01546) were likely to have RH. All 23 children with skull or nonskull fracture without intracranial hemorrhage did not have RH (P < 0.0001 both categories).ConclusionsRetinal hemorrhages were almost never found in the absence of intracranial hemorrhage and not found in the setting of fracture without intracranial hemorrhage.

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Section: Discussionmentioning

confidence: 98%

Risk factors associated with retinal hemorrhage in suspected abusive head trauma

Burkhart

Thurber²,

Chuang³

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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“…Li et al. (2011) suggested that patients with occipital skull fractures should be considered higher risk for RH based on the reported association with non‐parietal skull fractures and abuse. Thackeray et al.…”

Section: Discussionmentioning

confidence: 99%

“…(2010), Li et al. (2011) and Greiner et al. (2013) that signs of facial or head bruising or visible trauma put patients in a ‘high‐risk’ category for the presence of RH.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of non‐ocular findings for retinal haemorrhage in children evaluated for non‐accidental trauma

Giannakakos

Dosakayala

Huang

et al. 2021

Acta Ophthalmologica

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Purpose To determine non‐ocular examination findings in non‐accidental trauma (NAT) patients that are associated with retinal haemorrhage and warrant urgent examination by an ophthalmologist. Methods A hospital‐ and clinic‐based retrospective cross‐sectional and cohort study of children age 0–12 years who underwent workup for NAT over a span of nine years in a level I trauma and tertiary referral centre. Details of ocular and non‐ocular examination and imaging findings at the time of NAT evaluation were collected by chart review. Univariate and logistic regression analysis for association between retinal haemorrhage and non‐ocular examination findings was performed. Results A total of 557 patients with ophthalmology evaluation and 425 without were included in this study. All ages combined, none of the cutaneous signs of trauma or non‐skull fractures were associated with retinal haemorrhage on univariate analysis (p > 0.05). By logistic regression, subdural or extra‐axial haemorrhage (OR = 16.2; 95% CI [5.11–51.3]), occipital lobe insult (OR = 6.2; 95% CI [1.77–21.6]) and Glasgow coma score (GCS) <15 (OR = 5.8; 95% CI [1.96–17.4]) were significant predictors of retinal haemorrhage. Conclusion Subdural or undistinguished extra‐axial haemorrhage, GCS <15, and occipital lobe insult are risk factors for the presence of retinal haemorrhage in patients with suspected NAT and their presence warrant urgent dilated fundus examination by an ophthalmologist. The presence of cutaneous trauma or non‐skull bone fractures without the aforementioned risk factors does not warrant ophthalmology evaluation.

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“…There are studies indicating that RH rarely occur without SDH , and it was recently demonstrated that RH are probably secondary to high intracranial pressure , which can be caused by an SDH and result in encephalopathic symptoms. But we cannot be sure whether birth‐related SDH is always symptom‐free or how long a birth‐related SDH can remain after delivery.…”

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confidence: 99%