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So Young Kim, Andrew J Baldwin, Donny Suh; Comparison of the characteristics of retinal hemorrhages in abusive head trauma versus normal vaginal delivery. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1528.
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© ARVO (1962-2015); The Authors (2016-present)
Retinal hemorrhages (RH) are one of the hallmarks of abusive head trauma (AHT); however RHs are also encountered with normal vaginal deliveries (NVD), and thus present the clinician with a diagnostic dilemma. In order to further elucidate differing characteristics between the two groups, a comparison study was performed which evaluated RH in AHT versus NVD.
20 patients with AHT and 200 NVD infants with retinal hemorrhages (RH) from 2013 to 2015were included in this study. Pattern, size, extent and severity were compared using Retcam images between the two groups. Severities were calculated using the Philadelphia RH grading scale.
The RH size was significantly larger in AHT compared to the NVD group (3.1±0.512 vs 0.96±0.046 disc diameters, respectively). The AHT group also demonstrated a higher incidence of RH involving all three retinal layers compared to the NVD group (60% vs 0.6%, respectively, p<0.001). Vitreous hemorrhages were encountered more commonly in the AHT group (54.3%) in comparison to the NVD group (1.5%) (p<0.001). Overall, the grading score demonstrated higher scores in the AHT group than the NVD group (7.15±0.948vs 3.59±0.274, respectively). All patients in AHT group demonstrated one or more other findings including, epidural hemorrhage, loss of consciousness and seizure (100%) contrary to the NVD group (0%) (p<0.0001). The number of RH and involved zones were not significantly different amongst the two groups (p=0.495, p=0,034 respectively).
AHT presented with more severe retinal findings than NVD including: larger RH size, higher percentage involving all three retinal layers, higher percentage of vitreous hemorrhages, and higher Philadelphia RH grading scale scores. In cases where the NVD retinal findings are more extensive than anticipated, it becomes important to explore other factors suggestive of AHT such as history of loss of consciousness, history of seizures, and epidural hemorrhages on neuroimaging.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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