Abstract
Abstract: :
Purpose: Recent evidence points to a link between acute life threatening events (ALTE) and Shaken Baby Syndrome (SBS). In 1995 we observed that a small group of well appearing patients with nonspecific ALTE symptoms had retinal hemorrhages as the initial clue that inflicted head injury was the cause of the ALTE. The observations prompted our recent study tracking admissions with ALTEs to assess the magnitude of the problem of abusive head injury and emphasize the critical role that an ophthalmologist should play in the evaluation of this clinical entity. Methods: This report is based on data from a prospective series of infants under 12 months of age who were admitted to The Children's Hospital between November 1, 1996 and June 30, 1999 after presenting to the hospital emergency department with an ALTE. A physician data manager visited the pediatric floor of the hospital and the 14–bed pediatric intensive care unit on a daily basis. She identified patients meeting the above inclusion criteria by examining the charts of all newly admitted infants. She followed these patients until discharge, recording on a standardized data collection instrument detailed information including the initial history and physical examination, diagnostic testing done in the hospital, and the final diagnosis. Results: Of the 249 study subjects 122 (49%) had complete fundoscopic examinations performed by an attending ophthalmologist. Eleven patients had positive findings on their eye exams. Of the patients with positive findings 4 had retinal hemorrhages, 1 had isolated immature retinal vascularization, 1 had immature vascularization and icteric sclerae, 1 had a stable preexisting corneal transplant, 1 had congenital nasolacrimal duct obstruction, 1 had bilateral optic atrophy, 1 had poor visual fixation for age, and 1 had a blunted macular reflex. It was interpreted that except for the retinal hemorrhages, each of the positive eye findings was either benign or related to a chronic disease process and unrelated to the ALTE. The only positive eye finding that was instrumental in focusing the workup and leading to a diagnosis, i.e. inflicted injury was retinal hemorrhages. Conclusion: Since the consequences of delayed or missed diagnosis of SBS are dire, we believe it is imperative that Ophthalmologists be aware of their potentially life saving role as consultants in the prompt evaluation of infants admitted to a hospital with ALTE.
Keywords: clinical (human) or epidemiologic studies: prevalence/incidence