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samiksha fouzdar jain, Linda Morgan, austin svec, CLAIRE SVEC, Suzanne B Haney, sandra albery, Donny Suh; Clinical features of confirmed abusive head trauma cases compared to Not abusive head trauma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2429.
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© ARVO (1962-2015); The Authors (2016-present)
Child abuse is a leading cause of death in infants in the United States, often the result of abusive head trauma (AHT).The purpose of this retrospective analysis is to identify ocular and systemic findings in confirmed cases of AHT and compare them to a Non-abusive head trauma (NAHT).
A retrospective chart review of 165 patients with suspected abuse who presented at Children’s Hospital and Medical Center in Omaha, Nebraska from 2013 to 2015 was performed. Diagnosis of abusive head trauma was made after comprehensive history and meticulous ocular and systemic examination performed by emergency room physicians, ophthalmologists, radiologists and the Hospital Child Protection Team. The analysis was divided into two groups: AHT vs Non-abusive head trauma (NAHT). NAHT group comprises of accidental trauma, abusive trauma without significant apparent head involvement on initial evaluation and unconfirmed AHT cases, while AHT involved significant abusive head involvement confirmed by Pediatric Abuse specialist.
Analysis revealed AHT (n=30), NAHT (n=135). Male preponderance was present in group AHT: 53.3.0% vs NAHT: 55.5 %. Seizures were present in 43.3% AHT;7.4% NAHT and loss of consciousness was present in 50.0% of AHT patients as compared to 5.18% in NAHT group. Facial ecchymosis was seen in 30.0% of AHT and 7.4% of NAHT respectively. The other striking difference was presence of subdural hemorrhage (SDH) in 96.7% in AHT and 20 % in NAHT. Retinal findings included retinal hemorrhages in 63.3% in AHT and were absent in NAHT. As well, vitreous hemorrhage was seen in 36.6% of AHT patients and absent in NAHT.
None of the cases of non-abusive head trauma (NAHT) had retinal hemorrhages. Presence of retinal hemorrhage aids in the diagnosis of AHT but their absence does not preclude the diagnosis, as one thirds of those patients diagnosed with AHT lacked retinal hemorrhages. Subdural hemorrhage is the most remarkable associated clinical finding in AHT patients. SDH in NAHT patients was mild or minimal and was associated with skull fracture or benign subarachnoid fluid (BESS).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 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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