Performance and Yield of Retinal Examinations in Cases of Suspected Physical Abuse Without Intracranial Injury

Retinal hemorrhages (RHs) are reported as rare in children with concerns for physical abuse without intracranial injury (ICI). The current performance of retinal examinations in this population is unknown. We sought to assess factors associated with performing a retinal examination in young children without ICI and describe the yield of these examinations.

We performed a retrospective, multicenter cross-sectional study of children younger than 2 years undergoing subspecialty physical abuse evaluations between February 2021 and August 2023. Children were excluded if they had ICI, lacked neuroimaging, had RHs prompting evaluation for abuse, or died. Outcomes were (1) performance of a retinal examination and (2) yield of these examinations. We used descriptive statistics to report frequencies and proportions, and χ 2 or Fisher exact tests to assess unadjusted associations between clinical and consult characteristics with performance of retinal examinations.

Among 2591 children without ICI, retinal examinations were obtained in 10.5% (272). Performance of a retinal examination was significantly associated with younger age, in-person CAP evaluation, transfer status, CAPNET site, presence of high-risk bruising, presence of high-risk fractures, presence of subconjunctival hemorrhage, evidence of head trauma, and ill appearance. Four (1.5%) of the 272 children receiving retinal examinations had RHs on examination, all of which had potential alternate explanations for the RHs.

Retinal examinations rarely reveal RHs in young children without ICI who are undergoing abuse evaluations, suggesting that these examinations may be safely deferred in this population. Retinal examinations may be warranted in cases of suspected strangulation or other signs of ocular trauma.