PDF(Pubmed)
Abstract：
BACKGROUND: In the case of sudden unexpected death in infancy (SUDI), eye examination is systematic to detect retinal hemorrhages (RH) that are a crucial hallmark for abusive head trauma (AHT). The aim of this study is to assess the ability of non-invasive post-mortem fundus photographs (PMFP) to detect RH in case of SUDI.
METHODS: Bicentric retrospective analysis of consecutive cases of SUDI under 2 years of age were managed by two French SUDI referral centers with PMFP by RetCam (Clarity Medical Systems USA). PMFP were reviewed randomly, twice, by three independent ophthalmologists blinded for clinical data.
RESULTS: Thirty cases (60 eyes) were included. Median age was 3.5 months (interquartile [1.6; 6.0]). No child died of AHT. Image quality was sufficient to assert presence or absence of RH in 50 eyes (83%). Sufficient quality rate was significantly higher when the post-mortem interval was inferior to 18 h (91%, 42/46) as opposed to over 18 h (57%, 8/14, p=0.0096). RH were found in six eyes (10%), four children (13%), with excellent inter and intra-raters\' concordance (Cohen\'s Kappa from 0.81 [0.56-1.00] to 1.00 [1.00-1.00]).
CONCLUSIONS: PMFP can detect RH in case of SUDI and is a relevant systematic screening test to be carried out as soon as the deceased child arrives in the hospital. It can decrease the need of eye removal for pathological examination, but further studies are needed to define the best decision algorithm.
METHODS: Bicentric retrospective analysis of consecutive cases of SUDI under 2 years of age were managed by two French SUDI referral centers with PMFP by RetCam (Clarity Medical Systems USA). PMFP were reviewed randomly, twice, by three independent ophthalmologists blinded for clinical data.
RESULTS: Thirty cases (60 eyes) were included. Median age was 3.5 months (interquartile [1.6; 6.0]). No child died of AHT. Image quality was sufficient to assert presence or absence of RH in 50 eyes (83%). Sufficient quality rate was significantly higher when the post-mortem interval was inferior to 18 h (91%, 42/46) as opposed to over 18 h (57%, 8/14, p=0.0096). RH were found in six eyes (10%), four children (13%), with excellent inter and intra-raters\' concordance (Cohen\'s Kappa from 0.81 [0.56-1.00] to 1.00 [1.00-1.00]).
CONCLUSIONS: PMFP can detect RH in case of SUDI and is a relevant systematic screening test to be carried out as soon as the deceased child arrives in the hospital. It can decrease the need of eye removal for pathological examination, but further studies are needed to define the best decision algorithm.
摘要：
背景：在婴儿期（SUDI）突然意外死亡的情况下，眼睛检查是系统的，以检测视网膜出血（RH），这是虐待性头部创伤（AHT）的重要标志。这项研究的目的是评估非侵入性尸检眼底照片（PMFP）在SUDI情况下检测RH的能力。
方法：双中心回顾性分析连续2岁以下的SUDI病例，由法国两个SUDI转诊中心通过RetCam（美国ClarityMedicalSystems）进行PMFP管理。PMFP被随机审查，两次,由三名独立眼科医生对临床数据不知情。
结果：30例60眼。中位年龄为3.5个月（四分位数间[1.6;6.0]）。没有孩子死于AHT。图像质量足以证明50只眼睛(83%)中存在或不存在RH。当尸检间隔低于18小时时，足够的质量率显着提高(91%，42/46），而不是超过18小时（57%，8/14，p=0.0096）。六只眼睛（10％）中发现了RH，四个孩子(13%)，具有出色的评估者之间和内部一致性（科恩的Kappa从0.81[0.56-1.00]到1.00[1.00-1.00]）。
结论：PMFP可以在SUDI的情况下检测RH，并且是相关的系统筛查测试，将在死亡儿童到达医院后立即进行。它可以减少病理检查需要切除眼睛，但是需要进一步的研究来定义最佳的决策算法。
方法：双中心回顾性分析连续2岁以下的SUDI病例，由法国两个SUDI转诊中心通过RetCam（美国ClarityMedicalSystems）进行PMFP管理。
结果：30例60眼。
结论：PMFP可以在SUDI的情况下检测RH，并且是相关的系统筛查测试，将在死亡儿童到达医院后立即进行。
