Abstract
Purpose :
Retinal hemorrhages (RH) are highly specific for abusive head trauma (AHT) in the pediatric population. Limited data exists regarding the relationship between changes in coagulation parameters and RH. We performed a retrospective case-control study to determine the correlation between the presence of RH with changes in measurements of coagulation.
Methods :
Charts of patients 3 years or younger with AHT at Memorial Hermann Hospital—Texas Medical Center from January 2007 to December 2017 were reviewed. Patients with a history of RH or intraocular disease were excluded. Coagulation profiles including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), D-dimer, and fibrinogen were recorded. The two-sample t-test was used to compare coagulation profile patterns in the presence and absence of RH. The analysis was conducted for all patients as well as excluding patients with injuries resulting in death.
Results :
166 patients with mean age of 9.4 months (±8.3) were included. 107 (64%) patients were male, and 128 (77%) had RH. Statistically significant differences in PT (P=0.001), INR (P=0.002), and D-dimer (P=0.012) were found between patients with and without RH. These 3 profiles were higher in patients with RH (15.45±3.45 s for PT, 1.29±0.57 for INR, and 10.11±8.14 μg/ml for D-dimer) compared to those without (13.95±1.81 s for PT, 1.10±0.19 for INR, and 3.45±5.98 μg/ml for D-dimer).
Excluding 24 patients (22 with RH and 2 without) with injuries resulting in death yielded similar results, P=0.028, 0.019, <0.001 for PT, INR, and D-dimer, respectively. However, the mean and standard deviation (SD) of these 3 profiles in RH (n=106) were reduced (14.74±1.02 s for PT, 1.19±0.29 for INR, and 7.35±6.82 μg/ml for D-dimer). In patients without RH (n=36) the mean and SD remained similar (14.74±2.02 s for PT, 1.08±0.19 for INR, and 1.69±1.55 μg/ml for D-dimer).
Conclusions :
PT, INR, and D-dimer were significantly elevated when RH were present. D-dimer demonstrated the largest increase in patients with RH, and values above 3 μg/ml are likely predictive of RH. When patients with injuries resulting in death were excluded from the analysis, coagulation parameters were increased to a lesser degree when compared to the initial analysis. This suggests the degree of elevation in PT, INR, and D-dimer may correlate with the severity of AHT.
This is a 2020 ARVO Annual Meeting abstract.