Retinal hemorrhage variation in inertial versus contact head injuries.

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DOI: 10.1016/j.chiabu.2023.106606


BACKGROUND: Abusive head trauma (AHT) is frequently accompanied by dense/extensive retinal hemorrhages to the periphery with or without retinoschisis (complex retinal hemorrhages, cRH). cRH are uncommon without AHT or major trauma.

OBJECTIVE: The study objectives were to determine whether cRH are associated with inertial vs. contact mechanisms and are primary vs. secondary injuries.

PARTICIPANTS AND SETTING: This retrospective study utilized a de-identified PediBIRN database of 701 children < 3-years-old presenting to intensive care for head trauma. Children with motor vehicle related trauma and preexisting brain abnormalities were excluded. All had imaging showing head injury and a dedicated ophthalmology examination.

METHODS: Contact injuries included craniofacial soft tissue injuries, skull fractures and epidural hematoma. Inertial injuries included acute impairment or loss of consciousness and/or bilateral and/or interhemispheric subdural hemorrhage. Abuse was defined in two ways, by 1) predetermined criteria and 2) caretaking physicians/multidisciplinary team's diagnostic consensus.

RESULTS: PediBIRN subjects with cRH frequently experienced inertial injury (99.4 % (308/310, OR = 53.74 (16.91-170.77)) but infrequently isolated contact trauma (0.6 % (2/310), OR = 0.02 (0.0004-0.06)). Inertial injuries predominated over contact trauma among children with cRH sorted AHT by predetermined criteria (99.1 % (237/239), OR = 20.20 (6.09-67.01) vs 0.5 % (2/339), OR = 0.04 (0.01-0.17)). Fifty-nine percent of patients with cRH,consciousness, and inertial injuries lacked imaging evidence of brain hypoxia, ischemia, or swelling.

CONCLUSIONS: cRH are significantly associated with inertial angular acceleration forces. They can occur without brain hypoxia, ischemia or swelling suggesting they are not secondary injuries.

Journal Title

Child abuse & neglect



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MeSH Keywords

Child; Humans; Infant; Child, Preschool; Retinal Hemorrhage; Retrospective Studies; Craniocerebral Trauma; Child Abuse; Ischemia; Hypoxia, Brain


Abusive head trauma; Child physical abuse; Retinal hemorrhages; Retinoschisis; Traumatic brain injury


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