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KM Stoessel, KA Bechtel, JM Leventhal, CC Duncn, DB Berinstein, RF Gariano; Retinal Hemorrhage in Accidental and Non-Accidental Pediatric Closed Head Trauma . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4509.
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Purpose: To compare the incidence and severity of retinal hemorrhage in accidental and intentional pediatric head trauma. Methods: Consecutive children between the ages of one month and two years admitted to our institution with closed head trauma were considered for study. The diagnosis was secured on the basis of history, physical examination and neuroimaging (CT and/or MRI scan). Determination of child abuse associated with the injury was based on evaluation of the present trauma, past history, family and social evaluation, and radiography. All children in whom pupillary dilation was permissable underwent dilated indirect ophthalmoscopic examination within 48 hours of admission. Results: Fifty eight children with closed head trauma were enrolled. Of these, 49/58 sufferred accidental trauma, and 9/58 sufferred abuse-related trauma. Both groups were comparable with regard to age, gender, and incidence of intracranial hemorrhage. In the accidental trauma group, 3/49 (6%) of patients exhibited intraretinal hemorrhage, which was unilateral in 2 of 3, and typically mild. In the abuse-related group 7/9 (78%) of patients exhibited intraretinal hemorrhage, which was typically bilateral, widespread, and severe. Conclusion: These preliminary data indicate that qualitative and quantitative features of retinal hemorrhage may be useful to distinguish accidental from intentional pediatric closed head trauma.
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