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Risk factors associated with retinal hemorrhage in suspected abusive head trauma
Zachary N Burkhart1, Clinton J Thurber2, Alice Z Chuang2
1Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, Texas; Robert Cizik Eye Clinic, Houston, Texas.
Insights
Retinal hemorrhages in suspected abusive head trauma are strongly linked to intracranial bleeding. Fractures without brain injury did not show retinal hemorrhages, indicating a need for comprehensive evaluation.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Forensic Pathology
Background:
- Retinal hemorrhage (RH) is a critical finding in suspected abusive head trauma (AHT).
- Identifying risk factors for RH in pediatric AHT is crucial for diagnosis and child protection.
Purpose of the Study:
- To investigate the risk factors associated with retinal hemorrhage (RH) in pediatric patients suspected of abusive head trauma (AHT).
Main Methods:
- A retrospective case-control study analyzed records of 168 children (0-3 years) hospitalized for suspected AHT.
- Children were grouped into cases (with RH) and controls (without RH).
- Logistic regression identified risk factors, analyzing medical history, symptoms, and injury characteristics.
Main Results:
- Children with lethargy, altered mental status, or subdural hemorrhage were more likely to have RH.
- Other radiologic findings like cerebral ischemia and organ injury were also associated with RH.
- Importantly, no RH was observed in children with fractures but without intracranial hemorrhage.
Conclusions:
- Retinal hemorrhages in pediatric abusive head trauma are almost always accompanied by intracranial hemorrhage.
- The absence of RH in fractures without intracranial hemorrhage is a significant diagnostic indicator.
Purpose:
To determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects.
Methods:
Records of children aged 0-3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case-control study. Children were classified into case and control groups based on RH presence. Medical history, presenting symptoms, reasons, and characteristics of injury were recorded. Logistic regression analysis was performed to identify risk factors.
Results:
A total of 168 children (104 males) were included. Of these, 103 were classified as cases and 65 as controls. The mean age (with standard deviation) was 9.3 ± 8.3 months (range, 1 day-36 months). Of the 103 cases, 22 (21%) had subretinal hemorrhage, 9 (9%) had retinoschisis, and 1 (1%) had vitreous hemorrhage. Children presenting with lethargy or altered mental status (P < 0.0001), subdural hemorrhage (P < 0.0001), and other radiologic findings (eg, cerebral ischemia, diffuse axonal injury, hydrocephalus, or solid organ injury; P = 0.01546) were likely to have RH. All 23 children with skull or nonskull fracture without intracranial hemorrhage did not have RH (P < 0.0001 both categories).
Conclusions:
Retinal hemorrhages were almost never found in the absence of intracranial hemorrhage and not found in the setting of fracture without intracranial hemorrhage.
