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Abstract：
OBJECTIVE: Accurate identification of child physical abuse is crucial during the evaluation of injured children. Retinal hemorrhages (RH) are used for diagnosis, but clear criteria for screening with direct fundoscopic exam are lacking. We sought to identify key factors associated with RH to guide evaluations.
METHODS: Electronic medical records for patients <1 year of age presenting to a Level I Pediatric Trauma Center with unwitnessed head injury from January 2015 to December 2018 were retrospectively reviewed. Multivariable logistic regression was used to identify factors associated with RH.
RESULTS: Two hundred and seventy-six patients were included; 63% underwent direct fundoscopic examination, of which 23% were positive and 77% were negative for RH. Unscreened patients tended to be older and have isolated skull fractures. Multivariable regression analysis revealed that abnormal GCS and subdural hemorrhage were positively associated with a diagnosis of retinal hemorrhage, while isolated skull fracture was negatively associated.
CONCLUSIONS: Children under 1 year of age with subdural hemorrhage have a greater risk of associated RH and should undergo routine screening with direct fundoscopic examination. Conversely, those with isolated skull fractures may not require an ophthalmology consultation. Standardized screening protocols may help reduce the risk of missing child physical abuse.
METHODS: III (Diagnostic Test).
METHODS: Electronic medical records for patients <1 year of age presenting to a Level I Pediatric Trauma Center with unwitnessed head injury from January 2015 to December 2018 were retrospectively reviewed. Multivariable logistic regression was used to identify factors associated with RH.
RESULTS: Two hundred and seventy-six patients were included; 63% underwent direct fundoscopic examination, of which 23% were positive and 77% were negative for RH. Unscreened patients tended to be older and have isolated skull fractures. Multivariable regression analysis revealed that abnormal GCS and subdural hemorrhage were positively associated with a diagnosis of retinal hemorrhage, while isolated skull fracture was negatively associated.
CONCLUSIONS: Children under 1 year of age with subdural hemorrhage have a greater risk of associated RH and should undergo routine screening with direct fundoscopic examination. Conversely, those with isolated skull fractures may not require an ophthalmology consultation. Standardized screening protocols may help reduce the risk of missing child physical abuse.
METHODS: III (Diagnostic Test).
摘要：
目的：在评估受伤儿童的过程中，对儿童身体虐待的准确识别至关重要。视网膜出血（RH）用于诊断，但是缺乏明确的直接眼底镜检查筛查标准。我们试图确定与RH相关的关键因素来指导评估。
方法：对2015年1月至2018年12月到I级小儿创伤中心就诊的1岁以下患者的电子病历进行回顾性分析。多变量logistic回归用于确定与RH相关的因素。
结果：纳入了二百七十六例患者；63%接受了直接胃镜检查，其中23%为RH阳性，77%为RH阴性。未经筛查的患者往往年龄较大，并且有孤立的颅骨骨折。多因素回归分析显示GCS异常和硬膜下出血与诊断视网膜出血呈正相关,而孤立性颅骨骨折呈负相关。
结论：1岁以下儿童硬膜下出血有更大的相关RH风险，应接受直接胃镜检查的常规筛查。相反，那些孤立的颅骨骨折可能不需要眼科咨询。标准化的筛查方案可能有助于降低错过儿童身体虐待的风险。
方法：III（诊断测试）。
方法：对2015年1月至2018年12月到I级小儿创伤中心就诊的1岁以下患者的电子病历进行回顾性分析。多变量logistic回归用于确定与RH相关的因素。
结果：纳入了二百七十六例患者；63%接受了直接胃镜检查，其中23%为RH阳性，77%为RH阴性。未经筛查的患者往往年龄较大，并且有孤立的颅骨骨折。多因素回归分析显示GCS异常和硬膜下出血与诊断视网膜出血呈正相关,而孤立性颅骨骨折呈负相关。
结论：1岁以下儿童硬膜下出血有更大的相关RH风险，应接受直接胃镜检查的常规筛查。相反，那些孤立的颅骨骨折可能不需要眼科咨询。标准化的筛查方案可能有助于降低错过儿童身体虐待的风险。
方法：III（诊断测试）。
