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Ryan Drumright, Bo Huang, Lee Moore; Review of suspected non-accidental head injury cases at Batson Children's Hospital. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6053.
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Retinal hemorrhage has been reported to occur in association with various types of non-accidental head injury (NAHI). These include subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), epidural hemorrhage (EDH), and skull fracture. The purposes of this study were to evaluate the association between the presence of retinal hemorrhage and the presence of various types of NAHI and to evaluate the association between the presence of extra-cranial skeletal fracture and retinal hemorrhage. We tested the hypotheses that there would be an association between the presence of retinal hemorrhage and SDH and an association between the presence of extra-cranial skeletal fracture and retinal hemorrhage in patients suspected to be victims of NAHI.
This was a retrospective cross-sectional study of patients less than 5 years of age who were evaluated for NAHI with any of the following diagnoses: SDH, SAH, EDH, or skull fracture. A total of 210 charts were reviewed. After exclusion of 137 patients who did not undergo ophthalmologic examination for suspected NAHI, 73 patients were included in the data analysis. Chi-square testing was used to evaluate the association between the presence of retinal hemorrhage and each specific NAHI diagnosis (SDH, SAH, EDH, and skull fracture) as well as the association between the presence of extra-cranial skeletal fracture and retinal hemorrhage.
Forty-one patients had SDH, 13 had SAH, 2 had EDH, and 43 had skull fracture. Twenty-two patients had more than one NAHI diagnosis. Retinal hemorrhage was present in 28 patients (38.4%). The presence of retinal hemorrhage was highly associated with the presence of SDH (p < 0.001), but there was no significant association found with the presence of SAH, EDH, or skull fracture. Extra-cranial skeletal fractures were present in 15 patients and showed marginal association with the presence of retinal hemorrhage (p = 0.053).
Retinal hemorrhages are highly associated with SDH in patients that are suspected to be victims of NAHI, but they are not associated with SAH or skull fracture. These results support a shaking mechanism for the development of these injuries. The number of patients with EDH was too few to draw any conclusions on its association with retinal hemorrhage. Extra-cranial skeletal fractures are more common in NAHI patients with retinal hemorrhage but did not now show a statistically significant association.
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