Ophthalmology Examinations in Children With Skull Fractures and Underlying Focal Hemorrhage.
Document Type
Article
Publication Date
6-1-2025
Identifier
DOI: 10.1097/PEC.0000000000003334
Abstract
OBJECTIVES: To assess the frequency and yield of retinal examination in children below 2 years old undergoing abuse evaluations in the setting of skull fracture(s) and small underlying intracranial hemorrhage.
METHODS: This cross-sectional study used CAPNET, a multicenter child physical abuse network, to identify children below 2 years with a skull fracture(s) and intracranial injury limited to an underlying small focal intracranial hemorrhage undergoing subspeciality child abuse evaluations. Our outcomes of interest were (1) the performance of a retinal examination, (2) the identification of retinal hemorrhages, and (3) associations of clinical factors and CAPNET site with the performance of retinal examinations. We hypothesized that retinal hemorrhages would be identified in < 5% of patients.
RESULTS: Of 242 children who met inclusion criteria, the majority (189, 78.1%) presented with a reported history of accidental trauma, and most (211, 87.2%) lacked additional injuries. Only 9 (3.7%) had loss of consciousness and/or seizures/seizure-like activity. The majority (201, 83.1%) had low concern for abuse. Overall, 104 (43.0%) children underwent retinal examinations, of which 0 had retinal hemorrhages (one-sided 95% CI: 0-2.8%). Children without a reported accidental mechanism of injury ( P =0.004), those with intermediate/high concern for abuse ( P < 0.001), and children with occipital fractures ( P =0.008) were more likely than their counterparts to undergo retinal examination. The proportion of children undergoing retinal examination varied by CAPNET site ( P < 0.001).
CONCLUSIONS: Our findings suggest that it may be reasonable to forgo retinal examinations in children below 2 years of age with skull fracture(s) and intracranial injury limited to an underlying small focal hemorrhage who are overall neurologically well-appearing.
Journal Title
Pediatric emergency care
Volume
41
Issue
6
First Page
407
Last Page
414
MeSH Keywords
Humans; Cross-Sectional Studies; Child Abuse; Male; Infant; Female; Skull Fractures; Retinal Hemorrhage; Intracranial Hemorrhages
PubMed ID
40071580
Keywords
CAPNET; child abuse; ophthalmology examinations; retinal hemorrhage; skull fracture
Recommended Citation
Breeden K, Christian CW, Wood JN, et al. Ophthalmology Examinations in Children With Skull Fractures and Underlying Focal Hemorrhage. Pediatr Emerg Care. 2025;41(6):407-414. doi:10.1097/PEC.0000000000003334
COinS
