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Published on: September 11, 2013
Retinal haemorrhages associated with fatal paediatric infections
Marcus C Salvatori1, Patrick E Lantz2
1Oxford University Hospitals NHS Trust, UK.
Insights
Retinal hemorrhages (RHs) in young children are often linked to abusive head trauma. However, this study shows infections can also cause RHs, challenging previous diagnostic assumptions.
Area of Science:
- Ophthalmology
- Pediatrics
- Forensic Pathology
Background:
- Retinal hemorrhages (RHs) in infants and young children are frequently considered indicative of non-accidental (abusive) head trauma by physicians.
- Selective use of indirect ophthalmoscopy in suspected child abuse cases has led to diagnostic bias, potentially misattributing RHs caused by infection, coagulopathy, or accidental trauma.
Observation:
- This study presents an autopsy case series of four children (≤3 years old) who died from infections.
- Post-mortem monocular indirect ophthalmoscopy revealed retinal hemorrhages in all four cases.
Findings:
- The laterality, number, type, and location of RHs in these infection-related fatalities are discussed.
- Proposed mechanisms for RH formation in pediatric infection fatalities are summarized.
- Ophthalmological findings previously considered diagnostic of abusive head trauma were observed in association with infective processes.
Implications:
- The findings challenge the exclusive association of RHs with abusive head trauma.
- This research highlights the potential for iatrogenic misdiagnosis of child abuse in cases of infection.
- It underscores the need for a broader differential diagnosis when RHs are detected in pediatric cases.
Abstract:
For many physicians, retinal haemorrhages (RHs) in infants and young children remain highly diagnostic of non-accidental (abusive) head trauma. Because clinicians have applied indirect ophthalmoscopy selectively to cases of suspected child abuse, the association between RH and other conditions such as infection, coagulopathy and accidental trauma has encountered habitual bias, creating the potential for iatrogenic misdiagnosis of child abuse. We present an autopsy case series of four children, aged three years old or younger, in whom RHs were detected by post-mortem monocular indirect ophthalmoscopy after the patients had died from infections. We discuss the laterality, number, type and location of RHs in these cases, and summarize proposed mechanisms of RH formation in fatalities from paediatric infection. We demonstrate that many of the ophthalmological findings that have been considered diagnostic of abusive head trauma can also occur in association with infective processes.
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