Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Collections
    • Blog
  • Multimedia
    • Audio
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Collections
    • Blog
  • Multimedia
    • Audio
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
American Academy of Pediatrics
Child Abuse & Neglect

Retinal Exams in Abused Children With Normal Neuroimaging

AAP Grand Rounds September 2013, 30 (3) 32; DOI: https://doi.org/10.1542/gr.30-3-32
Quiz
  • Article
  • Info & Metrics
  • Comments
Loading
Download PDF

Source: Greiner MV, Berger RP, Thackeray JD, et al. Dedicated retinal examination in children evaluated for physical abuse without radiographically identified traumatic brain injury. J Pediatr. 2013; 163( 2): 527– 531; doi: 10.1016/j.jpeds.2013.01.063OpenUrlCrossRefPubMed

PICO

Question: Among children <10 years of age evaluated for physical abuse without traumatic brain injury, what is the rate of retinal hemorrhages?

Question type: Descriptive/Occurrence

Study design: Cross-sectional

Researchers from the multi-institutional Examining Siblings to Recognize Abuse (ExSTRA) research network sought to determine the prevalence of retinal hemorrhages (RH) in children <10 years of age who were being evaluated because of concerns for physical abuse and did not have evidence of traumatic brain injury (TBI). Additionally, the researchers aimed to evaluate the associations of RH in children who had no evidence of TBI, but who had abnormal mental status, facial bruising, and complex or occipital skull fracture. For the study, data collected at 20 participating US centers on all children <10 years of age who underwent subspecialty consultation for physical abuse between January 15, 2010 and April 30, 2011 were reviewed. TBI was defined as any radiological evidence of intracranial trauma, including subdural, subarachnoid, or epidural hemorrhages, brain contusions, and/or brain edema. The following information about RH was collected: presence, number, distribution, number of layers involved, and presence or absence of retinoschesis (splitting of the layers of the retina). RH that were numerous, multilayered, and extended to the periphery of the retina were considered to be “characteristic” for abuse.

Of the 1,122 eligible patients without TBI, 352 (32%) had dedicated examinations for RH, including 198 with complex or occipital skull fracture, altered mental status, or facial bruising. The median age of the 352 study children was 8.5 months (range 2–92 months). Among the 352 children, only 2 (0.6%; 95% CI, 0.1–2.0) had any RH identified. Neither child had “characteristic” RH that were thought to be “forensically significant” or retinoschesis. The authors calculate that it would require approximately 176 dedicated retinal examinations to detect 1 child with RH in this population, and that the RH detected would not likely be forensically significant.

The authors conclude that children being evaluated for physical abuse without TBI on neuroimaging may not require dedicated retinal examinations.

Commentary

Dr Anderst has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

  • retinal hemorrhage
  • child abuse

This study adds to the existing literature suggesting that RH, particularly forensically significant RH, are exceedingly rare in children with essentially normal neuroimaging and an examination for such is generally not indicated in this population.1,2 This research is the first multi-institutional, prospectively planned study to collect and analyze these types of data.

One previous case series identified 9 children with altered mental status in whom there was RH despite a normal initial head CT. However, that study included some children who had abnormalities on subsequent head imaging. Additionally, the cases were accrued via an international list serve, creating a potential selection bias.

A weakness of the current study is a lack of information on when the dedicated retinal examinations were done and who did them. In addition, the decision to obtain head imaging and/or dedicated examination for RH was left to the individual centers, potentially introducing selection bias. Nonetheless, this large series, taken in context with previous work, solidifies the notion that dedicated retinal examinations are usually not necessary in young children who may have been abused, but have normal neuroimaging studies.

References

  1. ↵
    1. Thackery JD,
    2. et al
    . Pediatrics. 2010;125(5):e1066–1071; doi:10.1542/peds.2009-2184
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Li S,
    2. et al
    . Arch Pediatr Adolesc Med. 2011;165:9137; doi:10.1001/archpediatrics.2011.150
    OpenUrlCrossRef
    1. Morad Y,
    2. et al
    . J Pediatr. 2003;142(4):431–434; doi:10.1016/j.jaapos.2004.06.007
    OpenUrlCrossRefPubMed
View Abstract
PreviousNext
Back to top

Advertising Disclaimer »

In this issue

AAP Grand Rounds
Vol. 30, Issue 3
1 Sep 2013
  • Table of Contents
  • Index by author
  • Complete Issue (PDF)
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Retinal Exams in Abused Children With Normal Neuroimaging
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Retinal Exams in Abused Children With Normal Neuroimaging
AAP Grand Rounds Sep 2013, 30 (3) 32; DOI: 10.1542/gr.30-3-32

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Quiz
Share
Retinal Exams in Abused Children With Normal Neuroimaging
AAP Grand Rounds Sep 2013, 30 (3) 32; DOI: 10.1542/gr.30-3-32
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents
  • Current Issue
  • Past Issues
  • Collections
  • Editorial Board
  • Overview
  • CME Quizzes
  • MOC Claiming

Jump to section

  • Article
    • References
  • Info & Metrics
  • Comments

Related Articles

  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Predictors of Resilience in High-Risk Young Children
  • Bruising in Infants Presenting to Pediatric EDs
  • Primary Care Interventions for Traumatic Stress in Children
Show more Child Abuse & Neglect

Similar Articles

Subjects

  • Ophthalmology
    • Ophthalmology
  • Child Abuse and Neglect
    • Child Abuse and Neglect
  • Journal Info
  • Editorial Board
  • Overview
  • Licensing Information
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • shopAAP
  • AAP.org
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
  • RSS
American Academy of Pediatrics

© 2021 American Academy of Pediatrics