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Evidence-Based Screening to Optimize the Yield of Positive Ophthalmologic Examinations in Children Evaluated for
Insights
Abnormal neuroimaging is strongly linked to retinal hemorrhages in suspected child abuse cases. This study proposes a screening algorithm using clinical and imaging factors to aid in diagnosis.
Area of Science:
- Pediatric Ophthalmology
- Child Abuse Forensics
- Medical Imaging in Pediatrics
Background:
- Retinal hemorrhages are a critical finding in suspected child abuse.
- Identifying associated nonocular findings aids in diagnosis and management.
- Previous studies have explored various clinical indicators.
Purpose of the Study:
- To identify nonocular findings associated with retinal hemorrhages in abused children.
- To develop a screening algorithm for ophthalmic evaluations in suspected child abuse.
- To validate and expand upon previously identified correlating factors.
Main Methods:
- Retrospective chart review of 274 children (≤36 months) with suspected abuse and ophthalmology consultation.
- Univariate and multivariate logistic regression analysis.
- Development of a predictive screening algorithm for ophthalmic work-up.
Main Results:
- Abnormal neuroimaging showed the strongest association with retinal hemorrhages (univariate OR 170).
- A multivariate model identified abnormal neuroimaging, low Glasgow Coma Scale score, altered mental status, seizures, vomiting, bruising, scalp hematoma, and skull fractures as predictive variables.
- The model demonstrated high predictive accuracy (c-statistic 0.980, P < .0001).
Conclusions:
- Clinical and imaging factors significantly correlate with retinal findings in suspected child abuse.
- The proposed evidence-based screening algorithm can improve diagnostic yield.
- The algorithm aims to optimize ophthalmologic examinations, reducing unnecessary evaluations.
Purpose:
To determine nonocular findings associated with significant retinal hemorrhage on dilated fundus examination in cases of suspected child abuse.
Methods:
This was a retrospective chart review from May 2014 to August 2021 at a level-1 trauma center. Two hundred seventy-four patients met the following inclusion criteria: (1) children 36 months and younger; (2) concern for child abuse; and (3) had an ophthalmology consultation. Through univariate and multivariate logistic regression, the study produced a screening algorithm for ophthalmic work-up in child abuse.
Results:
One or more abnormal neuroimaging findings had a statistically significant association with retinal hemorrhages and produced the strongest association with a univariate odds ratio of 170 (confidence interval: 10.245 to > 999.999). The multivariate model (P < .0001 with a c-statistic of 0.980) proposes using the following variables for predicting retinal hemorrhage on examination: abnormal neuroimaging, Glasgow Coma Scale score less than 15, altered mental status on examination, seizure activity, vomiting, bruising, scalp hematoma/swelling, and skull fractures.
Conclusions:
This study elucidates clinical and imaging factors that correlate to retinal findings, validating previously studied variables and introducing new variables to be considered. The authors propose an evidence-based screening algorithm to increase the yield of positive dilated examinations and decrease the burden of potentially unnecessary child abuse ophthalmologic examinations. [.
