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Retinal hemorrhages in low-risk children evaluated for physical abuse
Simiao Li1, Ellen Mitchell, Janet Fromkin
1Department of Pediatrics, Child Advocacy Center, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
Insights
In children evaluated for abusive head trauma, a specific set of low-risk criteria can identify those unlikely to have retinal hemorrhages (RH). This finding suggests that dilated eye exams may not be necessary for all evaluated children, reducing unnecessary procedures.
Area of Science:
- Pediatric Ophthalmology
- Child Abuse and Neglect
- Forensic Medicine
Background:
- Retinal hemorrhage (RH) is a concerning finding in children evaluated for abusive head trauma (AHT).
- Identifying children at low risk for RH is crucial to avoid unnecessary invasive examinations.
Purpose of the Study:
- To determine the prevalence of RH in children without intracranial injury undergoing AHT evaluation.
- To validate criteria for identifying low-risk children who do not require a dilated eye examination.
Main Methods:
- Retrospective medical record review of 194 children evaluated for physical abuse.
- Analysis of children without intracranial injury who underwent dilated eye exams.
- Assessment against predefined low-risk criteria (no intracranial hemorrhage, normal mental status, no head/face bruising).
Main Results:
- 141 of 194 children (72.7%) met the low-risk criteria.
- None of the children meeting low-risk criteria had RH.
- 2 of 53 children (3.8%) not meeting criteria had RH.
Conclusions:
- The validated low-risk criteria can reliably identify children who do not need a dilated eye examination during AHT evaluation.
- Implementing these criteria can significantly reduce the number of children undergoing unnecessary eye examinations.
Objectives:
To describe the prevalence of retinal hemorrhage (RH) in children without intracranial injury who are being evaluated for abusive head trauma and to validate previously derived criteria for identifying patients within this population who are at low risk of having RH on dilated eye examination.
Design:
Medical record review.
Setting:
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center from January 1, 2006, to April 30, 2010.
Participants:
One hundred ninety-four infants and children evaluated for physical abuse by the hospital Child Protection Team who did not have intracranial injury and who underwent a dilated eye examination to evaluate for RH.
Main Outcome Measure:
Number of children with RH who met a set of low-risk criteria: no intracranial hemorrhage with or without a simple, nonoccipital skull fracture, normal mental status, and no bruising on the head or face.
Results:
Of the 194 patients without intracranial injury who underwent dilated eye examination, 141 children (72.7%) met low-risk criteria. None of these 141 patients had RH. Of the 53 participants who did not meet low-risk criteria, 2 children (3.8%) had RH.
Conclusions:
In children evaluated for physical abuse who fulfill a set of low-risk criteria, the dilated eye examination should not be a necessary component of the abuse evaluation. Use of these criteria can significantly decrease the number of children who need to undergo a dilated eye examination as part of an evaluation for abusive head trauma.
