Accidental head trauma and retinal hemorrhage

Area of Science:

• Pediatric Ophthalmology
• Trauma Surgery
• Forensic Pathology

Background:

• Retinal hemorrhage and intracranial hemorrhage in children are often indicators of abuse.
• The forces causing these injuries in abuse cases are typically unknown.
• Accidental causes require investigation to differentiate from abuse.

Purpose of the Study:

• To determine the incidence of retinal hemorrhage in pediatric head injuries from known accidental causes.
• To correlate retinal hemorrhage with forces sufficient to cause skull fracture or intracranial hemorrhage.
• To aid in differentiating accidental head trauma from non-accidental trauma in children.

Main Methods:

• Reviewed 525 hospital admissions for head injuries.
• Selected 200 pediatric cases with head injuries and documented forces.
• Excluded 30 cases due to suspected abuse or GSWs; 170 eligible cases.
• Ophthalmologic evaluation for retinal hemorrhage in 140 children.

Main Results:

• Two children (out of 140 evaluated) presented with retinal hemorrhages.
• Both positive cases involved severe head injuries from side-impact car accidents.
• Retinal hemorrhage was found to be rare in accidental pediatric head injuries.

Conclusions:

• Retinal hemorrhage in pediatric head injury is uncommon under accidental circumstances.
• The presence of retinal hemorrhage in accidental head trauma suggests extraordinary, high-impact forces.
• Findings support careful evaluation to distinguish accidental from abusive head trauma.