@article{ref1,
title="Retinal hemorrhage variation in inertial versus contact head injuries",
journal="Child abuse and neglect",
year="2023",
author="Weeks, Kerri and Musick, Matthew and Frazier, Terra N. and Herman, Bruce E. and Hymel, Kent P. and Armijo-Garcia, Veronica and Carroll, Christopher L. and Rockter, Adam and Levin, Alex V. and Feldman, Kenneth W. and Sokoloff, Michael and Marinello, Mark and Haney, Suzanne B.",
volume="149",
number="",
pages="e106606-e106606",
abstract="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. <br><br>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. <br><br>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. <br><br>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, <24 h altered consciousness, and inertial injuries lacked imaging evidence of brain hypoxia, ischemia, or swelling. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0145-2134",
doi="10.1016/j.chiabu.2023.106606",
url="http://dx.doi.org/10.1016/j.chiabu.2023.106606"
}