June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Clinical Characteristics of Retinal Hemorrhages in Abusive Head Trauma versus Normal Vaginal Delivery; a Potential Pathophysiology of Mechanism of Injury
Author Affiliations & Notes
  • Donny W Suh
    Department of Ophthlamology, University of Nebraska, Omaha, Nebraska, United States
  • Alexander Won Suh
    Department of Ophthlamology, University of Nebraska, Omaha, Nebraska, United States
  • So Young Kim
    Department of Ophthlamology, University of Nebraska, Omaha, Nebraska, United States
  • Footnotes
    Commercial Relationships   Donny Suh, None; Alexander Suh, None; So Young Kim, None
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2428. doi:
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      Donny W Suh, Alexander Won Suh, So Young Kim; Clinical Characteristics of Retinal Hemorrhages in Abusive Head Trauma versus Normal Vaginal Delivery; a Potential Pathophysiology of Mechanism of Injury. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2428.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Retinal hemorrhage (RH) is one of the hallmarks of abusive head trauma (AHT); however, RH is also encountered with normal vaginal deliveries (NVD). To further elucidate differing characteristics between the two groups, a comparison study was performed which evaluated RHs in an AHT group versus an NVD group. Furthermore, the translational and rotational mechanics of the injury in the two groups are discussed.

Methods : Thirty patients with AHT and 200 NVD infants with retinal hemorrhages (RH) evaluated from 2013 to 2015 were included in this study. Pattern, size, extent, and severity were compared using Retcam images. Also, the severity of the RH each group was calculated using the RH grading scores.

Results : RH size was significantly larger in AHT patients compared to the NVD group (3.1±0.512 vs 0.96±0.046 disc diameters, respectively. The AHT group demonstrated a higher RH incidence involving all three retinal layers compared to the NVD group (60% vs 0.6%, respectively, p<0.001). Vitreous hemorrhages were more common in the AHT group (54.3%) in comparison to the NVD group (1.5%) (p<0.001). Overall, RH 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 the AHT group demonstrated one or more other systemic findings, including subdural hemorrhage, loss of consciousness and seizure (100%) in contrast to the NVD group (0%) (p<0.0001). The number of RHs and involved zones were not significantly different in either group (p=0.495, p=0,034 respectively).

Conclusions : AHT presented with more severe retinal findings than NVD, including larger RH size, higher percentages involving all three retinal layers and vitreous hemorrhages, and higher RH grading scores.
Therefore, it is important to explore other factors suggestive of AHT when NVD retinal findings are more extensive than anticipated. Key differences in retinal findings may be related to variation in vector forces. NVD apply a translational force while AHT apply both translational and rotational forces. Rotational forces add a critical centripetal force component and allow greater range for acceleration. Repetitive changes of acceleration with centripetal force suggests that AHT exerts more detrimental damage to the eye.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Retinal Hemorrhage in Abusive Head Trauama

Retinal Hemorrhage in Abusive Head Trauama

 

Retinal Hemorrhage in Nornal Vaginal Delivery

Retinal Hemorrhage in Nornal Vaginal Delivery

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