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Retinal Hemorrhages: Abusive Head Trauma or Not?

Jennifer B Hansen1, Emily F Killough, Mary E Moffatt

  • 1Assistant Professor (Hansen, Killough) and Professor (Moffatt), Divisions of Child Abuse and Neglect, Professor (Moffatt), Emergency Medicine, Assistant Professor (Hansen, Killough) and Professor (Moffatt, Knapp), Department of Pediatrics, Assistant Professor (Killough) and Professor (Knapp), Department of Graduate Medical Education, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO.

Pediatric Emergency Care
|September 5, 2018
PubMed

Insights

Severe, multilayered retinal hemorrhages (RHs) with retinoschisis in infants are highly specific indicators of abusive head trauma, distinguishing it from other causes.

Area of Science:

  • Ophthalmology
  • Pediatrics
  • Forensic Medicine

Background:

  • Abusive head trauma (AHT) is a significant cause of infant morbidity and mortality.
  • Retinal hemorrhages (RHs) are common findings in children with AHT.

Purpose of the Study:

  • To review the evaluation of children with RHs.
  • To differentiate RHs caused by AHT from other etiologies.
  • To discuss the pathophysiology and distinguishing features of AHT-related RHs.

Main Methods:

  • Review of existing literature on retinal hemorrhages in children.
  • Focus on differential diagnosis and distinguishing features of AHT-related RHs.
  • Discussion of ophthalmologic consultation indications and examination timing.

Main Results:

  • Non-AHT causes of RHs typically present nonspecific patterns.
  • Severe, multilayered RHs extending to the retinal periphery, especially with retinoschisis, are specific to AHT.
  • Retinoschisis is rarely associated with accidental trauma, and such events are usually well-documented.

Conclusions:

  • Ophthalmologic findings, particularly severe peripheral RHs with retinoschisis, are critical in diagnosing AHT.
  • Distinguishing AHT-related RHs from other causes is crucial for appropriate child protection.
  • Understanding the significance of specific RH patterns aids in timely diagnosis and intervention.

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