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Ocular findings and long-term outcomes in pediatric abusive head trauma
Camsy Huang1, Alyssa Low1, Zuhair Zaidi1
1Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas; Children's Medical Center Dallas, Dallas, Texas.
Insights
Abusive head trauma in children often causes severe vision loss. Disk pallor and fractures predict poor visual outcomes, while vitrectomy offers no clear benefit. Early identification is crucial for affected infants.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Forensic Medicine
Background:
- Pediatric abusive head trauma (AHT), or shaken baby syndrome, is a leading cause of child abuse mortality and disability.
- Ocular and systemic findings in AHT require characterization to understand long-term outcomes.
Purpose of the Study:
- To characterize ocular and systemic findings in pediatric abusive head trauma.
- To identify predictors of long-term visual and developmental outcomes in AHT patients.
Main Methods:
- Retrospective cohort study of 38 AHT patients (2006-2022).
- Inclusion criteria: ophthalmology consultation, positive eye findings, high suspicion for abuse.
- Data analysis using logistic regression and Fisher exact test (P < 0.05).
Main Results:
- All patients had subdural hematomas; 74% required intubation.
- 95% of injured eyes had intraretinal hemorrhage; 70% had preretinal hemorrhage.
- Disk pallor independently predicted moderate-to-severe visual impairment (P < 0.001); fractures also correlated with worse vision. Vitrectomy showed no visual outcome improvement.
Conclusions:
- Disk pallor, skull fractures, and long bone fractures are associated with poor visual outcomes in pediatric abusive head trauma.
- Vitrectomy did not improve visual outcomes, possibly due to confounding factors.
- Understanding these predictors is vital for managing AHT and improving patient prognosis.
Background:
Pediatric abusive head trauma, colloquially known as shaken baby syndrome, is the most common cause of death and disability from child abuse. The purpose of this study was to characterize ocular and systemic findings in abusive head trauma and identify predictors of long-term visual and developmental outcomes.
Methods:
We conducted a retrospective cohort study of patients diagnosed with abusive head trauma at Children's Medical Center Dallas between 2006 and 2022. Inclusion criteria were ophthalmology consultation, positive eye findings, and high concern for abuse. Data was analyzed by logistic regression and the Fisher exact test, with significance at P < 0.05.
Results:
A total of 38 patients (24 males [63%]) were included. Mean age was 5.85 months (range, 1-20). All patients had subdural hematomas, and 74% required intubation. Of 73 injured eyes, 69 (95%) had intraretinal hemorrhage; 51 (70%), preretinal hemorrhage; 16 (22%), vitreous hemorrhage; and 11 (15%) subretinal hemorrhage. Three patients (8%) had unilateral findings. Disk pallor was a strong independent predictor of moderate to severe patient-level visual impairment (P < 0.001). Skull and long bone fractures were also associated with worse vision. Vitrectomy was performed in 15 eyes. Vitrectomy was not associated with improved visual outcomes compared to observation. 4 patients (11%) died during follow-up, and all had severe bilateral visual impairment.
Conclusions:
Disk pallor, skull fractures, and long bone fractures were associated with poor visual outcomes in patients with abusive head trauma. Vitrectomy was not associated with improved visual outcomes, potentially because of confounding variables.
