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Clinical comparison of ocular and systemic findings in diagnosed cases of abusive and non-abusive head trauma

Linda A Morgan1, Samiksha Fouzdar Jain1, Austin Svec2

  • 1Children's Hospital and Medical Center, Omaha, NE, USA, limorgan@childrensomaha.org.

Clinical Ophthalmology (Auckland, N.Z.)
|September 4, 2018
PubMed

Insights

Abusive head trauma (AHT) in infants is linked to significant ocular findings like retinal hemorrhages. Subdural hemorrhages and seizures are also key indicators differentiating AHT from non-abusive head trauma.

Area of Science:

  • Pediatrics
  • Forensic Medicine
  • Ophthalmology

Background:

  • Child abuse, particularly abusive head trauma (AHT), is a critical cause of infant mortality.
  • Identifying reliable diagnostic markers for AHT is crucial for timely intervention and prevention.

Purpose of the Study:

  • To identify and compare ocular and systemic findings in confirmed abusive head trauma (AHT) cases versus non-abusive head trauma (NAHT) patients.
  • To evaluate the diagnostic significance of specific clinical and imaging findings in differentiating AHT from NAHT.

Main Methods:

  • A retrospective chart review was conducted on 165 pediatric trauma patients admitted between 2013 and 2015.
  • Patients were categorized into AHT and NAHT groups based on clinical evaluation, ocular findings, and systemic signs by subspecialists.
  • Data on ocular hemorrhages, neuroimaging (subdural hemorrhages - SDHs), and neurological symptoms (seizures) were analyzed.

Main Results:

  • Of 165 patients, 30 were diagnosed with AHT and 127 with NAHT.
  • AHT patients exhibited significant ocular findings, including retinal hemorrhages (63%) and vitreous hemorrhages (37%), which were absent in the NAHT group (p<0.001).
  • Neuroimaging revealed SDHs in 97% of AHT patients versus 21% of NAHT patients. Seizures were present in 43% of AHT patients compared to 8% of NAHT patients.

Conclusions:

  • Retinal and vitreous hemorrhages are statistically significant indicators of AHT.
  • The absence of diffuse retinal hemorrhages does not rule out AHT, as over one-third of AHT cases lacked them.
  • Subdural hemorrhages, loss of consciousness, and a history of seizures are highly correlated with an AHT diagnosis.
Abstract

Keywords:
retinal hemorrhageseizuresubdural hemorrhage

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