Timely recognition of retinal hemorrhage in pediatric abusive head trauma evaluation

Burge, Lauren; Horne, Bethanie S. Van; Bachim, Angela; Bhatt, Amit; Donaruma, Marcella

doi:10.1016/j.jaapos.2020.11.014

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…In the present study, retinal hemorrhage was also significantly associated with increased odds of AHT. However, an eye examination was not always done within 48 hours of admission in the present study, and subtle retinal hemorrhage might disappear [21]. On the other hand, Scheller reported ten cases of retinal hemorrhage with no evidence of brain injury and suggested that clinicians should reassess the importance of retinal hemorrhage in the setting of suspected AHT [22].…”

Section: Plos Onementioning

confidence: 64%

Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

Akutsu

Nonaka

Kato³

et al. 2022

PLoS ONE

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Objective Subdural hematoma in infants or toddlers has often been linked to abuse, but it is not clear how many cases actually occur and how many are suspected of abuse. The purpose of this study was to investigate subdural hematoma in infants and toddlers in Japan. Methods This multicenter, retrospective study reviewed the clinical records of children younger than 4 years with head trauma who were diagnosed with any finding on head computed tomography (CT) and/or magnetic resonance imaging (MRI), such as skull fracture and/or intracranial injury. A total of 452 children were included. The group suspected to have been abused was classified as nonaccidental, and the group considered to have been caused by an accident was classified as accidental. Subdural hematoma and other factors were examined on multivariate analysis to identify which factors increase the risk of nonaccidental injuries. Results Of the 452 patients, 158 were diagnosed with subdural hematoma. Subdural hematoma was the most common finding intracranial finding in head trauma in infants and toddlers. A total of 51 patients were classified into the nonaccidental group, and 107 patients were classified into the accidental group. The age of patients with subdural hematoma showed a bimodal pattern. The mean age of the accidental group with subdural hematoma was significantly older than that in the nonaccidental group (10.2 months vs 5.9 months, respectively. p < 0.001). Multivariate analysis showed that patients under 5 months old, retinal hemorrhage, and seizure were significant risk factors for nonaccidental injury (odds ratio (OR) 3.86, p = 0.0011; OR 7.63, p < 0.001; OR 2.49, p = 0.03; respectively). On the other hand, the odds ratio for subdural hematoma was 1.96, and no significant difference was observed (p = 0.34). Conclusions At least in Japanese children, infantile subdural hematoma was frequently observed not only in nonaccidental but also in accidental injuries. In infants with head trauma, age, the presence of retinal hemorrhage, and the presence of seizures should be considered when determining whether they were abused. Subdural hematoma is also a powerful finding to detect abuse, but care should be taken because, in some ethnic groups, such as the Japanese, there are many accidental cases.

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Section: Plos Onementioning

confidence: 64%

Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

Akutsu

Nonaka

Kato³

et al. 2022

PLoS ONE

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“…It is highly recommended to perform a thorough eye examination within 48 h of the admission of any pediatric case suspected to have AHT or SBS. Despite this, nearly 19% of SBS cases are faced with a delay in primary fundoscopic examination [45]. The majority of these patients whose condition is complicated by delays, however, are usually older and present with isolated cranial fractures, which could partly explain the reason for postponement of the retinal examination [46].…”

Section: Shaken Baby Syndrome From the Ophthalmologists' Perspectivementioning

confidence: 99%

An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse

Shahraki,

Suh

2024

Children

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Abusive head trauma (AHT) is an extreme form of physical child abuse, a subset of which is shaken baby syndrome (SBS). While traumatic injury in children is most readily observed as marks of contusion on the body, AHT/SBS may result in internal injuries that can put the life of the child in danger. One pivotal sign associated with AHT/SBS that cannot be spotted with the naked eye is retinal injury (RI), an early sign of which is retinal hemorrhage (RH) in cases with rupture of the retinal vasculature. If not addressed, RI can lead to irreversible outcomes, such as visual loss. It is widely assumed that the major cause of RI is acceleration–deceleration forces that are repeatedly imposed on the patient during abusive shaking. Still, due to the controversial nature of this type of injury, few investigations have ever sought to delve into its biomechanical and/or biochemical features using realistic models. As such, our knowledge regarding AHT-/SBS-induced RI is significantly lacking. In this mini-review, we aim to provide an up-to-date account of the traumatology of AHT-/SBS-induced RI, as well as its biomechanical and biochemical features, while focusing on some of the experimental models that have been developed in recent years for studying retinal hemorrhage in the context of AHT/SBS.

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“…Zu beachten ist, dass sich intraretinale Blutungen relativ schnell innerhalb weniger Tage resorbieren können, während präretinale Blutungen deutlich länger persistieren können [13,14,16]. Bei pädiatrischem Verdacht auf ein STS soll daher eine augenärztliche Untersuchung der betroffenen Kinder möglichst innerhalb von 24 h nach Hospitalisierung erfolgen [1,10,12,16,20].…”

Section: Zeitpunkt Der Erstuntersuchung Art Der Durchführung Und Nach...unclassified

Stellungnahme zur augenärztlichen Untersuchung bei Verdacht auf ein Schütteltrauma-Syndrom (STS)

2023

Klin Monbl Augenheilkd

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Timely recognition of retinal hemorrhage in pediatric abusive head trauma evaluation

Cited by 6 publications

References 9 publications

Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse

Stellungnahme zur augenärztlichen Untersuchung bei Verdacht auf ein Schütteltrauma-Syndrom (STS)

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