TY  - JOUR
PY  - 2023//
TI  - Retinal hemorrhage variation in inertial versus contact head injuries
JO  - Child abuse and neglect
A1  - Weeks, Kerri
A1  - Musick, Matthew
A1  - Frazier, Terra N.
A1  - Herman, Bruce E.
A1  - Hymel, Kent P.
A1  - Armijo-Garcia, Veronica
A1  - Carroll, Christopher L.
A1  - Rockter, Adam
A1  - Levin, Alex V.
A1  - Feldman, Kenneth W.
A1  - Sokoloff, Michael
A1  - Marinello, Mark
A1  - Haney, Suzanne B.
SP  - e106606
EP  - e106606
VL  - 149
IS  - 
N2  - 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>
LA  - en
SN  - 0145-2134
UR  - http://dx.doi.org/10.1016/j.chiabu.2023.106606
ID  - ref1
ER  -