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Quantitative measurement of retinal hemorrhages in suspected victims of child abuse
Susannah Q Longmuir1, Resmiye Oral2, Amy E Walz2
1Department of Ophthalmology and Visual Sciences, University of Iowa; Department of Pediatrics, University of Iowa.
Insights
Quantitative measurement of retinal hemorrhages in abused children correlates with severe brain trauma and skeletal fractures, but not with death or hospital stay. This finding aids in diagnosing child abuse.
Area of Science:
- Ophthalmology
- Pediatrics
- Forensic Medicine
Background:
- Child abuse is a significant cause of mortality in young children.
- Retinal hemorrhages are a key indicator in diagnosing child abuse.
- Fundus photography is crucial for visualizing retinal findings.
Purpose of the Study:
- To assess the correlation between quantitative measurements of retinal hemorrhages and clinical indicators of abuse.
- To determine if specific retinal hemorrhage metrics predict abuse severity or outcomes.
Main Methods:
- Retrospective review of medical records of children suspected of abusive head trauma (2003-2013).
- Widefield retinal photography and ImageJ software used to measure hemorrhage-covered percentage (HCP) of the central retina.
- Data analyzed for correlation with neuroimaging, skeletal surveys, length of stay, death, and abuse classification (definite vs. possible).
Main Results:
- A significant correlation was found between retinal hemorrhage measurements and axial skeletal fractures (P=0.016).
- Retinal hemorrhage extent correlated with severe neuroimaging findings indicative of brain trauma (P=0.014).
- Quantitative retinal hemorrhage measurements differentiated between definite and possible abuse cases (P=0.023).
Conclusions:
- The quantitative assessment of retinal hemorrhages on fundus photography shows correlation with specific clinical findings in abused children.
- Measurement of retinal hemorrhages may serve as a valuable objective tool in the forensic evaluation of suspected child abuse.
- Further research can refine the utility of retinal hemorrhage quantification in clinical practice and legal contexts.
Purpose:
Child abuse is one of the leading causes of death in early childhood. The presence of retinal hemorrhages often supports the diagnosis. The purpose of this study was to determine whether the specific measurement of retinal hemorrhages when present on fundus photography correlates with other clinical findings typically seen in children suspected of having been abused.
Methods:
The medical records of children with retinal hemorrhages who were suspected of being victims of abusive head trauma from June 2003 to June 2013 and who had widefield retinal photography performed were retrospectively reviewed. Data collected included hemorrhage-covered percentage (HCP) of the central retina (posterior pole or 40° circle centered on fovea) measured by ImageJ in relation to death, length of hospital stay, presence of abnormal findings on neuroimaging or skeletal survey, and definite versus possible abuse.
Results:
Significant difference in retinal hemorrhage measured on fundus photography was found in patients with axial skeletal fracture (P = 0.016), signs of severe brain trauma on neuroimaging (P = 0.014) and definite versus possible abuse (P = 0.023). No correlation of quantitative measurement of the retinal hemorrhage to length of hospital stay, death, or the presence of skull fracture was found in this cohort.
Conclusions:
The quantitative measurement of total retinal hemorrhage when present on fundus photography centered on posterior pole in children suspected of having been abused correlated with some but not all findings typically seen in abused children.
