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Ophthalmology referral as part of a multidisciplinary approach to suspected abusive head trauma
Laura Donaldson1, Gloria Isaza2, Burke Baird3
1Division of Ophthalmology, McMaster University Department of Surgery, McMaster Children's Hospital, Hamilton, Ont.
Insights
Ophthalmology consultation is key in diagnosing abusive head trauma (AHT) in children. While not all retinal hemorrhages (RH) indicate AHT, specific patterns and retinoschisis are strong indicators.
Area of Science:
- Pediatric Ophthalmology
- Child Abuse Pediatrics
- Forensic Pathology
Background:
- Abusive head trauma (AHT) is a serious concern in pediatric medicine.
- Ophthalmologic findings, particularly retinal hemorrhages (RH), are crucial in diagnosing AHT.
- The role of ophthalmology consultation in the diagnostic workup of suspected AHT requires further elucidation.
Purpose of the Study:
- To determine the utility and findings of ophthalmology consultations in the investigation of children with suspected abusive head trauma (AHT).
Main Methods:
- Retrospective chart review of children under 3 years old evaluated for suspected AHT.
- Inclusion criteria: suspected AHT cases from January 2011 to December 2017.
- Data collected included clinical findings, neuroimaging, ophthalmologic examinations, and final diagnoses.
Main Results:
- Of 57 children investigated, 29 (50.9%) were diagnosed with AHT. Retinal hemorrhages (RH) were present in 40.4% of all patients, and 55.2% of the AHT group.
- Patients with AHT exhibited more widespread, multilayered RH, and posterior pole/periphery involvement compared to other etiologies.
- Retinoschisis was exclusively observed in the AHT group, representing a specific finding.
Conclusions:
- A multidisciplinary approach, including ophthalmology, is vital for diagnosing suspected AHT.
- While RH are not pathognomonic for AHT, specific characteristics and retinoschisis aid in diagnosis.
- Ophthalmologic examination is essential for identifying subtle or overt signs of AHT.
Objective:
To determine the use of ophthalmology consultation as part of investigation of children with suspected abusive head trauma (AHT).
Methods:
Retrospective chart review of children under age 3 years evaluated at McMaster Children's Hospital for suspected AHT from January 2011 to December 2017.
Results:
Fifty-seven children were investigated, and 29 (50.9%) of these were determined to have likely AHT. Eleven (19.3%) had other nonaccidental injuries. A mean of 3.6 consulting services were involved. Neuroimaging was performed for 52 patients (91.2%), including all patients in the AHT group. Intracranial hemorrhage (ICH) was present in 21 of the 29 AHT children (72.4%). All 57 patients had a dilated fundus examination, and retinal hemorrhages (RH) were seen in 23 patients (40.4%), including 16 (55.2%) in the AHT group. All patients with RH in AHT also had ICH. In the AHT group, there were more cases of hemorrhages too numerous to count (68.8% vs 28.6%), multilayered hemorrhages (75.0% vs 57.1%), and hemorrhages in the posterior pole and periphery (87.5% vs 42.9%) when compared with patients with RH from other etiologies. Retinoschisis was seen in the AHT group only in 3 patients (18.8%).
Conclusions:
A multidisciplinary approach is important when investigating suspected AHT. Not every child with RH had suffered AHT; however, children with AHT showed more widespread and more multilayered RH. The only finding specific to AHT was retinoschisis.
