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Clinical comparison of ocular and systemic findings in diagnosed cases of abusive and non-abusive head trauma

Authors Morgan LA, Fouzdar Jain S, Svec A, Svec C, Haney SB, Allbery S, High R, Suh DW

Received 25 January 2018

Accepted for publication 3 May 2018

Published 22 August 2018 Volume 2018:12 Pages 1505—1510


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Linda A Morgan,1 Samiksha Fouzdar Jain,1 Austin Svec,2 Claire Svec,2 Suzanne B Haney,1 Sandra Allbery,1 Robin High,2 Donny W Suh1,2

1Children’s Hospital and Medical Center, Omaha, NE, USA; 2University of Nebraska Medical Center, Omaha, NE, USA

Purpose: Child abuse is a leading cause of death in infants, which is often associated with abusive head trauma (AHT). The purpose of this retrospective analysis was to identify ocular and systemic findings in confirmed cases of AHT and compare them to a group of non-abusive head trauma (NAHT) patients.
Patients and methods: A retrospective chart review of 165 patients with accidental and non-accidental trauma admitted between 2013 and 2015 to Children’s Hospital and Medical Center in Omaha, NE, USA, was performed. Diagnosis of AHT was made after the analysis of ocular and systemic findings by various subspecialists. The NAHT group consisted of accidental trauma, abusive trauma without significant apparent head involvement on initial evaluation and unconfirmed AHT cases.
Results: Of the 165 presenting cases, 30 patients were diagnosed with AHT and 127 were diagnosed with NAHT. Ocular findings in AHT patients were significant for retinal hemorrhages (63%) and vitreous hemorrhages (37%), while NAHT patients had no ocular findings (p<0.001). Neuroimaging revealed subdural hemorrhages (SDHs) in 29 out of 30 AHT patients (97%) and in 27 out of 127 NAHT patients (21%). Seizures were present in 43% of AHT patients (n=13) and only in 8% of NAHT patients (n=10).
Conclusion: AHT has statistically significant findings of retinal and vitreous hemorrhages. The absence of diffuse retinal hemorrhages, however, does not preclude the AHT diagnosis as more than one-third of AHT patients lacked retinal hemorrhages. SDHs, loss of consciousness and history of seizures also have high correlation with a diagnosis of AHT.

Keywords: subdural hemorrhage, retinal hemorrhage, seizure

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