Abusive head trauma: a retrospective chart review of Omaha Children’s Hospital and Medical Center from 2013-2015

Abstract

Purpose : Child abuse is one of the leading causes of death during the infancy period, often attributable to abusive head trauma (AHT). Ophthalmologists are often consulted in these cases to evaluate for ocular sequela of AHT, in particular retinal hemorrhages. The aim of this retrospective chart review was to evaluate numerous issues often questioned in this medicolegal setting regarding the patients' history, physical exam, and imaging.

Methods : A retrospective chart review was performed on all of the cases in which the Pediatric Ophthalmology service was consulted to evaluate patients where there was concern for possible child abuse at Omaha Children’s Hospital and Medical Center from 2013-2015. The analysis was divided into three groups: AHT, Abusive No Head Trauma (ANHT), and Accidental (AT). ANHT was defined as non-accidental, abusive trauma without significant head involvement, while AHT involved significant abusive head involvement. A total of 165 cases were analyzed: AHT (n=32), ANHT (n=85), and AT (n=49). For each group, variables were analyzed for statistical significance through exact chi-square testing of independence.

Results : Analysis revealed a slight male preponderance (AHT: 55.0%; ANHT: 55.9%; AT: 56.2%). There was no significant difference in the age of presentation (AHT: 0.631±0.113; ANHT: 0.753±0.082; AT: 0.924±0.133 years-old). Similarly, there was no statistically significant difference amongst the groups in regards to delay in seeking medical care (P=0.37), previous abuse (P=0.20), or pre-existing medical conditions (P=0.58). AHT was more likely to present with a history of seizure (P<0.001) and history of loss of consciousness (P<0.001). The AHT group had higher percentages of facial ecchymosis (34.6%, P=0.002). On neuro-imaging, AHT had a higher percentage of parenchymal (14.3%, P=0.007), subdural (96.7%, P<0.001), and vitreous hemorrhages (62.9%, P<0.001). No vitreous hemorrhages were observed in the ANHT and AT groups.

Conclusions : AHT was more likely to present with a history of seizure and loss of consciousness and upon evaluation to have facial ecchymosis. Vitreous hemorrhage on neuro-imagining was only found in the AHT group and should raise the clinicians’ suspicion for AHT.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.