Retinal Hemorrhages in Children Following Fatal Motor Vehicle Crashes

Abstract

To demonstrate the severity of ocular findings in young children who died of injuries due to motor vehicle crashes. Methods: Case series of 10 children younger than 3 years who were fatally injured in motor vehicle crashes between January 1, 1994, and December 31, 2002. All children underwent autopsy that included eye examination. All available medical and autopsy records, pathology slides and photographs, and police and traffic department reports were reviewed for each case. Results: Eight patients had retinal hemorrhages, which extended into the periphery in 13 eyes and were bilateral in 7 patients. Three patients had elevated circular retinal folds. Six patients had hemorrhages below the internal limiting membrane, but no patients had deeper splitting of the retina. Nine patients had optic nerve sheath hemorrhages. Conclusion: The association of extensive, sometimes severe, ocular hemorrhages with fatal accidental trauma, compared with previous reports of accidental trauma with no or few hemorrhages, indicates the severity of injury required to cause hemorrhages of this magnitude.

Rare retinal haemorrhages in translational accidental head trauma in children

“…These severe high-impact head trauma scenarios go along with a major static load applied to the head for more than 200 ms (such as a heavy object falling on to the victim or a car driving over the victim's head). The same holds true for the eight deceased patients with extensive retinal haemorrhages reported by Kivlin et al 13 very recently. Haemorrhages were bilateral in seven patients and extended into the periphery in all patients.…”

“…Retinal haemorrhages almost always require severe life-threatening impact injury. [3][4][5][6][7][8][9][10][11][12][13] They are often relatively mild, isolated to the posterior pole and unilateral.…”

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

“…While the sensitivity for abusive head trauma of perimacular folds was 8% and of macular retinoschisis was 14%, their specificity was 100%, as the two findings were not seen in accidental trauma in any of the reviewed studies. However, these findings have been reported in case reports of fatal crush head injury, fatal motor vehicle accident with severe rotational and deceleration injury, and one fatal 11-meter fall, which also produced multiple skull fractures [17][18][19][20]. Therefore, when macular retinoschisis or retinal folds are present in a child not involved in a fatal car accident or who does not have multiple skull fractures (as from a high fall or crush injury), the positive predictive value of these findings for abusive head trauma remains 100% based upon the available literature.…”

“…The retinal hemorrhages most often are confined to the posterior pole, few in number and rarely subretinal. More severe retinal hemorrhages, even with extension to the retinal periphery, have been reported with severe motor vehicle accidents involving multiple acceleration-deceleration events, such as vehicle rollovers [18].…”

Vitreoretinal traction is a major factor in causing the haemorrhagic retinopathy of abusive head Injury? – Yes

“…3,4 Isolated accidental blunt head impact injury is rarely associated with retinal haemorrhage, 5,6 and when retinal haemorrhage does occur, the haemorrhages are few in number and largely confined to the posterior pole, with the exception perhaps of fatal head crush injury 7,8 and severe fatal motor vehicle accidents. 9 Over the last 35 years much research has been conducted to aid us in understanding the pathophysiology of retinal haemorrhage in abusive head injury. Multiple research lenses have been used to examine this issue and each continues to indicate the important role of vitreoretinal traction.…”