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Published on: April 21, 2022
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
Summary
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.
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