Retinal hemorrhages in children following fatal motor vehicle crashes: a case series
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Published on: September 11, 2013
Jane D Kivlin1, Melissa L Currie, V Jordan Greenbaum
1Department of Ophthalmology, Medical College of Wisconsin, 925 N 87th St, Milwaukee, WI 53226, USA. jkivlin@mcw.edu
Insights
Fatal motor vehicle crashes in young children often cause severe ocular hemorrhages, including retinal and optic nerve sheath hemorrhages. This highlights the significant trauma associated with such incidents.
Area of Science:
- Ophthalmology
- Forensic Pathology
- Pediatric Traumatology
Background:
- Motor vehicle crashes are a leading cause of accidental death in young children.
- Ocular injuries in pediatric trauma victims are not well-characterized.
- Understanding the spectrum of eye injuries can aid in determining the circumstances of fatal trauma.
Purpose of the Study:
- To document the frequency and severity of ocular findings in children under 3 years old who died from motor vehicle crash injuries.
- To correlate the extent of ocular hemorrhages with the severity of fatal accidental trauma.
Main Methods:
- A case series of 10 children younger than 3 years fatally injured in motor vehicle crashes.
- Comprehensive autopsy including detailed eye examination.
- Review of medical records, autopsy findings, and police reports.
Main Results:
- 80% of patients exhibited retinal hemorrhages, often bilateral and extending to the periphery.
- 30% had elevated circular retinal folds.
- 90% had optic nerve sheath hemorrhages.
- No patients showed deeper retinal splitting.
Conclusions:
- Severe ocular hemorrhages, including retinal and optic nerve sheath hemorrhages, are common in young children fatally injured in motor vehicle crashes.
- The presence of extensive hemorrhages suggests a high-magnitude injury, differentiating these cases from milder accidental trauma.
- Ocular findings can serve as indicators of the severity of fatal accidental trauma in pediatric motor vehicle crash victims.
Objective:
To demonstrate the severity of ocular findings in young children who died of injuries due to motor vehicle crashes.
Methods:
Case series of 10 children younger than 3 years who were fatally injured in motor vehicle crashes between January 1, 1994, and December 31, 2002. All children underwent autopsy that included eye examination. All available medical and autopsy records, pathology slides and photographs, and police and traffic department reports were reviewed for each case.
Results:
Eight patients had retinal hemorrhages, which extended into the periphery in 13 eyes and were bilateral in 7 patients. Three patients had elevated circular retinal folds. Six patients had hemorrhages below the internal limiting membrane, but no patients had deeper splitting of the retina. Nine patients had optic nerve sheath hemorrhages.
Conclusion:
The association of extensive, sometimes severe, ocular hemorrhages with fatal accidental trauma, compared with previous reports of accidental trauma with no or few hemorrhages, indicates the severity of injury required to cause hemorrhages of this magnitude.
