Abstract：
Retinal hemorrhages (RHs) are suggestive of abusive head trauma (AHT). Even so, controversy persists about other possible causes, a fact that hinders the diagnosis of abuse.
To determine the prevalence and patterns of RHs associated with increased intracranial pressure (ICP) in young children.
Prospective, single center study of children aged 29 days-3 years undergoing a lumbar puncture with opening pressure (OP) measured during routine clinical care in the emergency department, over a 4-year period. Children with known causes of RHs were excluded. All the children underwent a detailed ophthalmological examination within 72 h of admission. For children with RHs, an in-depth investigation was carried out to rule out AHT.
Thirty-four patients were included: 20(58.8 %) were boys, median age 11.7 months (range 1-33 months). Overall, 29(85.3 %) had clinical findings of increased ICP. The duration of symptoms was ≤4 days in all patients except one, in whom it was 1.5 months. The median OP was 27cmH2O (range 20-60cmH2O). One of the children was found to have RHs, with evaluation resulting in a diagnosis of AHT. No RHs were found in any of the others studied. Using the Wilson method, we can be confident to an upper limit of 95 % that the probability of RHs occurring secondary to increased ICP alone is at most 0.1.
RHs were not detected in patients with isolated nontraumatic increased ICP, measured via OP and diagnosed in the ED. Therefore, if RHs are detected, investigation into the possibility of AHT is warranted.
To determine the prevalence and patterns of RHs associated with increased intracranial pressure (ICP) in young children.
Prospective, single center study of children aged 29 days-3 years undergoing a lumbar puncture with opening pressure (OP) measured during routine clinical care in the emergency department, over a 4-year period. Children with known causes of RHs were excluded. All the children underwent a detailed ophthalmological examination within 72 h of admission. For children with RHs, an in-depth investigation was carried out to rule out AHT.
Thirty-four patients were included: 20(58.8 %) were boys, median age 11.7 months (range 1-33 months). Overall, 29(85.3 %) had clinical findings of increased ICP. The duration of symptoms was ≤4 days in all patients except one, in whom it was 1.5 months. The median OP was 27cmH2O (range 20-60cmH2O). One of the children was found to have RHs, with evaluation resulting in a diagnosis of AHT. No RHs were found in any of the others studied. Using the Wilson method, we can be confident to an upper limit of 95 % that the probability of RHs occurring secondary to increased ICP alone is at most 0.1.
RHs were not detected in patients with isolated nontraumatic increased ICP, measured via OP and diagnosed in the ED. Therefore, if RHs are detected, investigation into the possibility of AHT is warranted.
摘要：
背景：视网膜出血（RHs）提示滥用性头部创伤（AHT）。即便如此,关于其他可能原因的争议仍然存在，一个阻碍虐待诊断的事实。
目的：确定与幼儿颅内压（ICP）升高相关的RH的患病率和模式。
方法：前瞻性，单中心研究29天至3岁儿童在急诊科常规临床护理期间进行腰椎穿刺并测量开口压力（OP），在4年期间。排除已知病因的儿童。所有儿童在入院后72小时内接受了详细的眼科检查。对于有RH的孩子，进行了深入调查以排除AHT。
结果：包括34例患者：20例（58.8％）为男孩，中位年龄11.7个月（范围1-33个月）。总的来说,29例（85.3%）有ICP升高的临床表现。除一名患者外，所有患者的症状持续时间≤4天，其中有1.5个月。OP中位数为27cmH2O(范围为20-60cmH2O)。其中一个孩子被发现有RH，评估导致AHT的诊断。在任何其他研究中都没有发现RH。使用威尔逊方法，我们可以确信95%的上限,仅ICP升高后发生RHs的概率至多为0.1.
结论：在孤立的非创伤性ICP增加的患者中未检测到RHs，通过OP测量并在ED中诊断。因此,如果检测到RH，有必要对AHT的可能性进行调查。
目的：确定与幼儿颅内压（ICP）升高相关的RH的患病率和模式。
方法：前瞻性，单中心研究29天至3岁儿童在急诊科常规临床护理期间进行腰椎穿刺并测量开口压力（OP），在4年期间。排除已知病因的儿童。所有儿童在入院后72小时内接受了详细的眼科检查。对于有RH的孩子，进行了深入调查以排除AHT。
结果：包括34例患者：20例（58.8％）为男孩，中位年龄11.7个月（范围1-33个月）。总的来说,29例（85.3%）有ICP升高的临床表现。除一名患者外，所有患者的症状持续时间≤4天，其中有1.5个月。OP中位数为27cmH2O(范围为20-60cmH2O)。其中一个孩子被发现有RH，评估导致AHT的诊断。在任何其他研究中都没有发现RH。使用威尔逊方法，我们可以确信95%的上限,仅ICP升高后发生RHs的概率至多为0.1.
结论：在孤立的非创伤性ICP增加的患者中未检测到RHs，通过OP测量并在ED中诊断。因此,如果检测到RH，有必要对AHT的可能性进行调查。
