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Implementation of an Evidence-Based Retinal Evaluation Pathway for Pediatric Abusive Head Trauma
Nikole McLean1, Raquel Vargas-Whale2, Lisa Porterfield3
1Nikole McLean, Child Abuse Resource and Evaluation Team Doctor of Nursing Practice, Family Nurse Pracitioner, Advanced Forensic Nurse Practitioner, and Sexual Assault Nurse Examiner, Child Abuse Resource and Evaluation Department, Driscoll Children's Hospital, Corpus Christi, TX, USA.
Introduction:
Abusive head trauma (AHT) is a leading cause of morbidity and mortality in infants and young children. Retinal hemorrhages are important findings in suspected AHT and require timely ophthalmologic evaluation, yet standardized retinal evaluation processes and pediatric ophthalmology access remain inconsistent.
Methods:
This evidence-based practice improvement project used the Iowa Model within the SQUIRE 2.0 framework to implement a standardized retinal evaluation pathway at a Level III pediatric trauma hospital. Interventions included a retinal imaging protocol, staff competency training, standardized documentation, and teleophthalmology consultation. Sixty-two pediatric patients with suspected AHT were evaluated (31 pre-intervention, 31 post-intervention).
Results:
Documented pediatric ophthalmology diagnoses with follow-up recommendations increased from 0% pre-intervention to 77.4% post-intervention (Fisher's exact test, p < .001).
Conclusion:
A standardized retinal evaluation pathway significantly improved ophthalmologic review, documentation, and follow-up planning for pediatric patients with suspected AHT.
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