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Retinal Hemorrhages: Abusive Head Trauma or Not?

Hansen, Jennifer B., MD; Killough, Emily F., MD; Moffatt, Mary E., MD; Knapp, Jane F., MD

doi: 10.1097/PEC.0000000000001605
CME Review Article
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Abusive head trauma is an important cause of morbidity and mortality in infants and young children. Retinal hemorrhages (RHs) are frequently seen, particularly during dilated eye examination of these children. This review focuses on the evaluation of children with RH, with emphasis on the differential diagnosis, pathophysiology, and distinguishing features of RHs due to abusive head trauma. Many causes exist for RHs in infants and children. Most medical and accidental traumatic causes result in a pattern of RH that is nonspecific and not typical of the pattern and distribution of RHs seen in children with abusive head trauma. In children with intracranial hemorrhage and concerns for abuse, the finding of severe, multilayered RHs extending to the periphery of the retina is very specific for abuse as the cause of the findings, especially if retinoschisis is present. There are few other accidental traumatic mechanisms associated with retinoschisis, and the history of such a traumatic event is readily apparent. The indications for ophthalmologic consult, optimal timing of the eye examination, and significance of the findings are specifically discussed.

Assistant Professor (Hansen, Killough) and Professor (Moffatt), Divisions of Child Abuse and Neglect, Professor (Moffatt), Emergency Medicine, Assistant Professor (Hansen, Killough) and Professor (Moffatt, Knapp), Department of Pediatrics, Assistant Professor (Killough) and Professor (Knapp), Department of Graduate Medical Education, Children’s Mercy Hospital, University of Missouri–Kansas City School of Medicine, Kansas City, MO.

The authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

Reprints: Jennifer B. Hansen, MD, Division of Child Abuse and Neglect Office, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108 (e-mail: jbhansen@cmh.edu).

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