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The natural history of retinal hemorrhage in pediatric head trauma
Gil Binenbaum1, Wendy Chen2, Jiayan Huang3
1Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia; Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Insights
Intraretinal hemorrhages (IRH) in children with head trauma clear within weeks, while preretinal hemorrhages (PRH) can persist. The presence of numerous IRH suggests recent trauma, aiding in timing injury.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Forensic Medicine
Background:
- Ophthalmologists frequently evaluate retinal hemorrhages (RH) in pediatric head trauma cases.
- Determining the timing of head trauma is crucial for diagnosis and legal proceedings.
Purpose of the Study:
- To investigate the natural history of retinal hemorrhages in young children following head trauma.
- To identify specific patterns of RH that indicate the chronicity of head injuries.
Main Methods:
- Retrospective review of medical records for children under 2 years with head trauma and RH.
- Categorization of RH types (intraretinal, preretinal) and grading of intraretinal hemorrhage (IRH) severity.
- Analysis of RH resolution patterns over time through follow-up examinations.
Main Results:
- Intraretinal hemorrhages (IRH) resolved to mild or none within 1-2 weeks in most cases.
- Numerous IRH (TNTC) did not persist beyond a few days, with the longest isolated IRH lasting 32 days.
- Preretinal hemorrhages (PRH) were more persistent, lasting 5-111 days; their presence with few or no IRH suggests trauma days to weeks prior.
Conclusions:
- Rapid clearance of IRH suggests recent trauma (within days).
- Persistent PRH, especially with minimal IRH, indicates trauma occurred days to weeks earlier.
- Prompt ophthalmological examination (within 24-48 hours) is recommended for accurate timing of suspected traumatic injuries.
Background:
Ophthalmologists are commonly asked to interpret appearance of retinal hemorrhages (RH) in children with suspected traumatic head injury. We sought to determine the natural history of RH in young children with head trauma and to identify patterns suggestive of chronicity in order to help establish timing of suspected traumatic injury.
Methods:
The medical records of children <2 years of age with abusive or accidental head trauma and RH on initial fundus examination who had 1 or more follow-up examination were retrospectively reviewed. Types of RH (intraretinal, preretinal) were noted; intraretinal hemorrhage (IRH) severity was graded as mild (0-10), moderate (10-20), or severe (>20, too numerous to count [TNTC]).
Results:
A total of 91 eyes of 52 children were studied. All eyes had IRH (62 eyes with TNTC). In all but one eye, IRH resolved to none or mild within 1-2 weeks. TNTC IRH did not persist beyond a few days. The longest an isolated IRH persisted was 32 days. Preretinal hemorrhage (PRH) was present in 68 eyes, persisting 5-111 days. On initial examination, 25% of eyes had only IRH, 75% both PRH and IRH; no eyes had only PRH. At 2 weeks, 3% had only IRH, 18% both, and 45% only PRH. In no eyes did RH worsen.
Conclusions:
IRH clears rapidly, whereas PRH may persist for many weeks. The presence of TNTC IRHs indicates that trauma occurred within a few days prior to examination, whereas the presence of PRH with no or few IRHs suggests days to weeks since trauma. To accurately identify these patterns, eye examinations should be completed as soon as possible after admission, preferably within 24-48 hours.
