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Retinal hemorrhages and apparent life-threatening events

Ana Isabel Curcoy1, Victoria Trenchs, Marta Morales

  • 1Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona, Spain. acurcoy@hsjdbcn.org

Pediatric Emergency Care
|January 23, 2010
PubMed

Insights

Retinal hemorrhages are rare in apparent life-threatening events (ALTEs) in children under two. If found, it suggests nonaccidental head trauma requires investigation.

Area of Science:

  • Pediatrics
  • Ophthalmology
  • Forensic Medicine

Background:

  • Apparent life-threatening events (ALTEs) in infants and young children can mimic nonaccidental head trauma.
  • Retinal hemorrhages are a key indicator in diagnosing abusive head trauma.
  • The association between ALTEs and retinal hemorrhages requires clarification for accurate diagnosis.

Purpose of the Study:

  • To determine the prevalence of retinal hemorrhages in children diagnosed with ALTEs.
  • To aid in the differential diagnosis between ALTEs and nonaccidental head trauma.
  • To establish the likelihood of retinal hemorrhages solely due to ALTEs.

Main Methods:

  • Prospective study of 108 children aged 15 days to 2 years with ALTEs.
  • Ophthalmologic examinations conducted within 72 hours of admission.
  • Further investigations for systemic disorders or maltreatment if hemorrhages were detected.

Main Results:

  • No retinal hemorrhages were observed in any of the 108 children with ALTEs.
  • No cases of child abuse were identified in the study cohort.
  • The upper limit of 95% confidence for retinal hemorrhages resulting from ALTEs alone is 0.028.

Conclusions:

  • ALTEs alone are an unlikely cause of retinal hemorrhages in children under 2 years.
  • The presence of retinal hemorrhages in this age group warrants investigation for nonaccidental injury.
  • Distinguishing ALTEs from abusive head trauma is critical for appropriate medical and legal management.
Abstract

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