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Dedicated retinal examination in children evaluated for physical abuse without radiographically identified traumatic
Mary V Greiner1, Rachel P Berger, Jonathan D Thackeray
1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. mary.greiner@cchmc.org
Insights
Retinal hemorrhages are rare in children evaluated for physical abuse without traumatic brain injury (TBI). These findings suggest dedicated retinal exams may not be routinely necessary for this patient group.
Area of Science:
- Pediatric Ophthalmology
- Child Abuse Pediatrics
- Forensic Medicine
Background:
- Evaluating children for physical abuse is critical.
- Traumatic brain injury (TBI) is a concern in abusive head trauma.
- Retinal hemorrhages can be indicative of abuse but also other conditions.
Observation:
- This study analyzed data from the Examining Siblings to Recognize Abuse (ExSTRA) network.
- Children under 10 evaluated for abuse with neuroimaging showing no TBI were included.
- Dedicated retinal examinations were performed on a subset of these children.
Findings:
- Retinal hemorrhages were found in only 0.6% of children evaluated for physical abuse without TBI.
- The identified hemorrhages were few and isolated to the posterior poles.
- Clinical signs like facial bruising or altered mental status were not reliable predictors of retinal hemorrhages.
Implications:
- Forensically significant retinal hemorrhages appear uncommon in children with no TBI on imaging.
- Routine dedicated retinal examinations may not be necessary for children evaluated for abuse without TBI.
- This could refine diagnostic protocols and reduce unnecessary procedures.
Objective:
To determine the rate of retinal hemorrhages in children evaluated for physical abuse without traumatic brain injury (TBI) by diagnostic imaging.
Study Design:
This study was a prospectively planned, secondary analysis of the Examining Siblings to Recognize Abuse (ExSTRA) research network, and included only index children who presented with concerns for abuse. Subjects were eligible for the parent study if they were less than 10 years old and evaluated by a Child Abuse Physician for concerns of physical abuse. Child Abuse Physicians recorded results of all screening testing and determination of the likelihood of abuse in each case. For this analysis, we examined the results of dedicated retinal examinations for children with neuroimaging that showed no TBI. Isolated skull fractures were not considered to be TBI.
Results:
The original ExSTRA sample included 2890 index children evaluated for physical abuse. Of this group, 1692 underwent neuroimaging and 1122 had no TBI. Of these 1122 children, 352 had a dedicated retinal examination. Retinal hemorrhages were identified in 2 (0.6%) children. In both cases, there were few (defined as 3-10) hemorrhages isolated to the posterior poles; neither was diagnosed with physical abuse. The presence of facial bruising, altered mental status, or complex skull fractures was neither sensitive nor specific for retinal hemorrhage identification.
Conclusions:
Forensically significant retinal hemorrhages are unlikely to be found in children evaluated for physical abuse without TBI on neuroimaging, and such children may not require routine dedicated retinal examination.
