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Injuries Suggestive of Physical Abuse in Young Children With Subconjunctival Hemorrhages
Jennifer E Wolford1, Rachel P Berger1, Adelaide L Eichman1
1From the Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Insights
Subconjunctival hemorrhages in children are rare but can indicate occult injury. Even without other trauma signs, these eye findings warrant evaluation for physical abuse.
Area of Science:
- Pediatric ophthalmology
- Child abuse pediatrics
- Forensic medicine
Background:
- Subconjunctival hemorrhages (SCHs) in children can be associated with physical abuse.
- Understanding the significance of SCHs in pediatric evaluations is crucial.
Purpose of the Study:
- To compare children with and without SCHs evaluated by child abuse specialists.
- To analyze demographic characteristics, clinical presentations, medical evaluations, and injuries.
Main Methods:
- A case-control study using data from the Examining Siblings to Recognize Abuse (ExSTRA) research network.
- Fifty cases with SCHs were matched with 200 controls (4:1 ratio) by age and center.
- Descriptive statistics were used for comparisons.
Main Results:
- No significant differences in demographics, clinical characteristics, or medical evaluations between cases and controls.
- One-quarter of children with SCHs had no other external trauma signs.
- The rate of occult injuries was similar between children with SCHs and those with bruises.
Conclusions:
- SCHs are uncommon in children evaluated for abuse but often signal occult injury.
- The presence of SCHs, even without other trauma signs, necessitates an age-appropriate physical abuse evaluation.
- These findings underscore the importance of considering abuse in cases of pediatric SCHs.
Objective:
The aim of this study was to compare the demographic characteristics, clinical presentations, medical evaluation, and injuries identified in a cohort of children with and without subconjunctival hemorrhage who were evaluated by a child abuse specialist.
Methods:
This was a case-control study that used data from the ExSTRA (Examining Siblings to Recognize Abuse) research network. Subjects with a subconjunctival hemorrhage(s) were designated as cases. Four controls matched for age and participating center were included for each case. Descriptive statistics were used to compare cases and controls.
Results:
Fifty of the 2890 subjects in the parent study had a subconjunctival hemorrhage(s) and were designated as cases. The cases had a median (interquartile range) age of 5.0 months (2.0-23.6 months). Two hundred controls were matched to the cases. There was no difference in the demographics, clinical characteristics, medical evaluation, or rate of occult injuries identified in cases and controls. Almost one-quarter of children with subconjunctival hemorrhages had no other external sign of trauma but had the same rate of occult injuries as children with bruises.
Conclusions:
These data suggest that subconjunctival hemorrhages are relatively rare among children undergoing evaluation by a child abuse specialist, but that they are often an indicator of occult injury. Even in the absence of other external signs of trauma, the presence of subconjunctival hemorrhages should prompt an age-appropriate evaluation for physical abuse.
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