Maguire et al reviewed the significance of retinal hemorrhages in abusive and non-abusive head trauma. The authors are from Cardiff University, University Hospital of Wales, Southampton University and York Hospital in the UK.
Patient selection: child with head trauma
The OR for abusive head trauma when retinal hemorrhages are present is 14.7. Retinal hemorrhages were reported in 78% of children with abusive head trauma vs 5% with non-abusive trauma.
General features of retinal hemorrhages associated with abusive head trauma:
(1) bilateral
(2) numerous, and may be confluent
(3) extend to the periphery
(4) multilayered (which can be demonstrated on optical coherence tomography)
General features of retinal hemorrhages in non-abusive head trauma:
(1) unilateral
(2) few in number
(3) present in the posterior pole, with only about 10% extending to the periphery
No pattern of retinal hemorrhage is unique to abusive head trauma.
Other factors to consider:
(1) presence of other signs of child abuse
(2) exclusion of conditions that can also cause retinal hemorrhage (malaria, thrombocytopenia, profound anemia, vasculitis, meningitis, fall from height, crush injury, etc)
Other findings to look for and document:
(1) vitreous hemorrhages
(2) schisis cavities
(3) retinal folds
(4) retinal exudates
(5) papilledema
(6) optic nerve hemorrhage
(7) retinal detachment, tears or holes
(8) epiretinal membrane
(9) macular hole
(10) retinal neovascularization
(11) choroidal rupture
(12) retinal edema
(13) vitreous detachment
