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Prevalence of Retinal Hemorrhages in Infants Presenting with Isolated Long Bone Fractures and Evaluation for Abuse
Brian S Payne1, Timothy J Kutz2, Ann Di Maio1
1Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, St. Louis, Missouri.
Insights
In infants under one year old, isolated long bone fractures do not typically show retinal hemorrhages. Dilated eye exams may not be necessary for these specific pediatric fracture cases.
Area of Science:
- Pediatric Emergency Medicine
- Ophthalmology
- Child Abuse Evaluation
Background:
- Fractures are common reasons for pediatric emergency visits.
- Abusive head trauma evaluation is a concern in infants with fractures.
- Current guidelines suggest retinal exams may not be needed without intracranial injury, but evidence in infants is lacking.
Purpose of the Study:
- To determine the prevalence of retinal hemorrhages in infants under one year old with isolated long bone fractures.
- To evaluate the necessity of retinal examinations in this specific pediatric population.
Main Methods:
- Retrospective chart review of infants (<1 year) with acute long bone fractures or retinal hemorrhages.
- Exclusion criteria included head injury, altered mental status, motor vehicle accidents, multiple fractures, or extra-fracture injuries.
- Data sourced from trauma registry and ICD codes.
Main Results:
- No retinal hemorrhages were found in 78 infants with isolated long bone fractures who underwent dilated eye exams.
- 46 patients had retinal hemorrhages concerning for abuse, but none had isolated long bone fractures.
- 68 patients with isolated long bone fractures did not have retinal examinations.
Conclusions:
- Dilated eye examinations are unlikely to provide additional diagnostic information for infants under one year with isolated long bone fractures.
- Findings support the idea that not all infants with fractures require dilated eye exams for abuse evaluation.
Background:
Fractures are a frequent reason for emergency department visits and evaluation for abusive head trauma is an associated concern in infants. Recent guidelines have suggested that retinal examination may not be necessary in the absence of intracranial injury, but there is a lack of empirical evidence in infants < 1 year of age.
Objective:
Our aim was to evaluate the prevalence of retinal hemorrhages in infants with isolated long bone fractures.
Methods:
Retrospective chart review of infants < 1 year of age who presented to an urban, tertiary care pediatric hospital between January 2004 and April 2014 with the diagnosis of an acute long bone fracture or retinal hemorrhages. Patients were excluded for head injury, altered mental status, injury mechanism of motor vehicle accident, multiple fractures or injuries outside the fracture area. Patients were identified through trauma registry data and International Classification of Diseases codes.
Results:
One hundred and forty-six patients had isolated long bone fractures, of which 68 patients did not undergo a retinal examination and 78 patients had dilated eye examinations, with no patients identified as having retinal hemorrhages. There were 46 patients identified with retinal hemorrhages concerning for abuse. No patients with retinal hemorrhages had isolated long bone fractures.
Conclusions:
In infants < 1 year of age presenting with isolated long bone fractures, a dilated eye examination to evaluate for retinal hemorrhages is not likely to yield additional information. Our results support recent studies that a subset of children and infants may not require dilated eye examinations in the evaluation of possible abuse.
