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Timely recognition of retinal hemorrhage in pediatric abusive head trauma evaluation
Lauren R Burge1, Bethanie S Van Horne1, Angela Bachim1
1Department of Pediatrics, Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Insights
Delays in eye exams for suspected abusive head trauma are linked to pediatric intensive care unit admission, surgery, and seizures. Early neurosurgery consultation can prevent delayed diagnosis of retinal hemorrhages.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Forensic Medicine
Background:
- Retinal hemorrhages (RHs) are critical indicators of abusive head trauma in children with unexplained intracranial injury.
- Guidelines recommend eye examinations within 48 hours due to the rapid resolution of RHs.
Purpose of the Study:
- To identify clinical factors associated with delayed funduscopic examinations beyond the recommended 48-hour window.
Main Methods:
- Retrospective chart review of 203 pediatric patients with intracranial injury over three years.
- Data collected included demographics, intubation, pediatric intensive care unit (PICU) admission, extraventricular drain placement, seizures, vasopressor support, and other injuries.
- Multivariate logistic regression analyzed factors predicting delayed eye examinations.
Main Results:
- 19.2% of patients experienced delayed funduscopic examinations.
- Pediatric intensive care unit (PICU) admission, surgical intervention, and seizure activity were significant predictors of delay.
- Neurosurgical consultation demonstrated a protective effect against examination delays.
Conclusions:
- Rapid resolution of retinal hemorrhages in child abuse necessitates prompt ophthalmology evaluations.
- Early neurosurgery consultation is crucial for timely diagnosis in suspected child abuse cases.
Background:
Distinct patterns of retinal hemorrhages (RHs) are suggestive of abusive head trauma in the context of unexplained intracranial injury. Current recommendations encourage an eye examination within 48 hours of admission due to the rapid resolution of RH. The purpose of this study was to identify clinical factors associated with a delay in funduscopic examination outside the recommended 48 hours.
Methods:
Retrospective chart review was completed on all inpatient consultations by the Child Protection Team with evidence of intracranial injury on computed tomography or magnetic resonance imaging over 3 years at a large children's hospital. Extracted data included demographic characteristics, history of intubation, pediatric intensive care unit (PICU) admission, extraventricular drain placement, seizures, use of vasopressor support, and presence of other injuries. Descriptive statistics were used to describe the patient population, clinical characteristics, and outcomes. Multivariate logistic regression was used to identify factors associated with delayed eye examinations.
Results:
A total of 203 patients met inclusion criteria. Of those, 39 (19.2%) had a delay in initial funduscopic examination. Multivariate analyses revealed that PICU admission, surgical intervention, and seizure activity were significant predictors of delayed examination after controlling for multiple clinical factors. Neurosurgical consultation was shown to be protective against a delayed examination.
Conclusions:
Rapid resolution of RH may occur in child abuse. Prompt ophthalmology examinations and neurosurgery consultation when child abuse is suspected help avoid a delay in diagnosis.
