Correlation of Ocular and Systemic Findings and Manner of Death in Forensic Pediatric Autopsies: A 13 Year Experience

Abstract

Abstract: : Purpose: To correlate the ocular and systemic findings in forensic pediatric autopsies, with particular emphasis on the relationship(s) between intraocular and intracranial findings, and the classification of manner of death in these cases. Methods: Gross and microscopic examinations of 90 forensic pediatric autopsy cases from 1991 to 2004 were performed. Postmortem ocular examinations were performed by an experienced ophthalmic pathologist without knowledge of systemic autopsy findings. Ocular and systemic findings were subsequently correlated and tabulated. Statistical analysis when possible was performed by Fisher exact test or Chi square test. Results: Retinal hemorrhages were present in 53 of 90 (59%) cases, including 42 of 59 (71%) cases ruled as homicides, 3 of 10 (30%) natural deaths, 1 of 4 (25%) accidental deaths, and 7 of 17 (41%) cases where manner of death was undetermined (p<0.025). Retinal hemorrhages were highly correlated with intracranial meningeal hemorrhages (either subdural or subarachnoid, 49 of 90 (54%) cases: p<0.0001), but was only statistically significant for those cases deemed homicides (p<0.0001). Circular macular folds were present in 18 of 90 (20%) autopsy cases, and approached but did not reach statistical significance in cases ruled as homicides (16 of 59 (27%) cases: p=0.084) and in undetermined cases (2 of 17 (12%) cases: p=0.074). Conclusions: Retinal hemorrhages are common occurrences in the forensic pediatric autopsy population, and are highly correlated with intracranial meningeal hemorrhages. There is a statistically highly significant relationship between retinal hemorrhages and classification of manner of death as homicide. Association between circular macular folds and classification of manner of death as homicide approached but did not reach statistical significance in this series of cases.

Keywords: retina • macula/fovea • trauma