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Catching The Red Eye: A Retrospective Review Of Predictors Of Retinal Hemorrhage In Non-accidental Trauma
Alejandra M Casar Berazaluce, Zishaan Farooqui, Todd Jenkins, *Suzanne Moody, *Richard Falcone, *Kaaren Shebesta
Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Background (issue):
Accurate identification of non-accidental trauma (NAT) is crucial during the evaluation of pediatric trauma victims. Although intracranial and retinal hemorrhage (ICH and RH) are associated with NAT in children, evidence to guide the use of direct fundoscopic exam (DFE) as part of the screening process is lacking. The purpose of this study was to identify the highest risk associations for RH.
Methods:
Clinical data were retrospectively reviewed among 276 patients <1 year old presenting to a level 1 pediatric trauma center with unwitnessed head injury from January 2015 to December 2018. Multivariable logistic regression was used to identify predictors of RH.
Findings:
Of the 276 patients, 63% were screened with DFE. 40 (23%) were positive for RH and 133 (77%) were negative. Unscreened patients tended to be older, have isolated skull fractures, and were less likely to have intracranial injuries. Odds ratios (OR) for RH are shown in Figure 1. Multivariate regression found that SDH, GCS<15, and ISS>15 were positively associated with RH, while isolated skull fractures were inversely associated.
Conclusions (implications for practice):
Children <1 year old with SDH have a higher risk of RH and should undergo routine screening with DFE. Conversely, those with isolated skull fractures may not require it as part of their evaluation. Standardized screening protocols may reduce the risk of missed cases of NAT.


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