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Association between retinal findings and risk of mortality in pediatric abusive head trauma

Abdelrahman M Elhusseiny1, Jamal O Azhari2, Carson W Ercanbrack2

  • 1Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|January 29, 2026
PubMed

Insights

The severity and spread of retinal hemorrhages in abusive head trauma (AHT) are strong predictors of mortality in children. Detailed retinal exams can help assess survival outcomes.

Area of Science:

  • Ophthalmology
  • Pediatrics
  • Forensic Medicine

Background:

  • Abusive head trauma (AHT) is a severe form of child abuse with significant mortality.
  • Retinal hemorrhages are a common finding in AHT, but their prognostic significance requires further elucidation.
  • Understanding factors associated with mortality is crucial for clinical management and child protection.

Purpose of the Study:

  • To investigate the association between retinal findings, systemic factors, and socioeconomic status with mortality risk in pediatric patients diagnosed with AHT and retinal hemorrhages.
  • To determine the prognostic value of the grade, distribution, and morphology of retinal hemorrhages in predicting mortality.
  • To assess the influence of demographic and socioeconomic factors on mortality outcomes in AHT.

Main Methods:

  • Retrospective analysis of data from 91 children diagnosed with AHT and retinal hemorrhages, utilizing RetCam fundus photography.
  • Retinal hemorrhages were graded based on extent, spread, and morphology, leading to an overall retinal involvement classification (grades 1-3).
  • Logistic regression was employed to analyze associations between retinal findings, clinical variables, and mortality risk, adjusting for demographic and socioeconomic factors.

Main Results:

  • A total of 182 eyes from 91 children were analyzed; 20% of the children died.
  • Higher grades of retinal hemorrhages were significantly associated with increased mortality risk (P = 0.0004), with mortality rates escalating from 7% (grade 1) to 53% (grade 3).
  • Greater hemorrhage spread (grade C) and hypoxic-ischemic injury were strong predictors of mortality (OR = 17.43 and OR = 115.4, respectively), while morphology and socioeconomic factors were not significant.

Conclusions:

  • The grade and extent of retinal hemorrhages are potent predictors of mortality in pediatric AHT.
  • Detailed retinal examinations provide valuable prognostic information for assessing survival outcomes in children with AHT.
  • These findings underscore the importance of thorough ophthalmological evaluation in the management of suspected abusive head trauma.
Abstract

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