Abstract：
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.
The study objectives were to determine whether cRH are associated with inertial vs. contact mechanisms and are primary vs. secondary injuries.
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.
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.
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.
cRH are significantly associated with inertial angular acceleration forces. They can occur without brain hypoxia, ischemia or swelling suggesting they are not secondary injuries.
The study objectives were to determine whether cRH are associated with inertial vs. contact mechanisms and are primary vs. secondary injuries.
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.
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.
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.
cRH are significantly associated with inertial angular acceleration forces. They can occur without brain hypoxia, ischemia or swelling suggesting they are not secondary injuries.
摘要：
背景：虐待性头部创伤（AHT）通常伴有周围密集/广泛的视网膜出血，伴有或不伴有视网膜裂开（复杂的视网膜出血，cRH).没有AHT或严重创伤的cRH并不常见。
目的：研究目的是确定cRH是否与惯性接触机制，是主要的vs.二次伤害。
方法：这项回顾性研究利用了一个去识别的PediBIRN数据库，该数据库包含701名3岁以下接受重症监护的头部创伤儿童。排除患有机动车相关创伤和先前存在的大脑异常的儿童。所有患者的影像学检查均显示头部受伤，并进行了专门的眼科检查。
方法：接触性损伤包括颅面软组织损伤，颅骨骨折和硬膜外血肿.惯性损伤包括急性损伤或意识丧失和/或双侧和/或半球间硬膜下出血。虐待的定义有两种，通过1）预先确定的标准和2）护理医师/多学科团队的诊断共识。
结果：患有cRH的PediBIRN受试者经常经历惯性损伤（99.4％（308/310，OR=53.74（16.91-170.77）），但很少发生孤立的接触性创伤（0.6％（2/310），OR=0.02(0.0004-0.06))。根据预定标准（99.1％（237/239），在cRH分类为AHT的儿童中，惯性损伤优先于接触性损伤，OR=20.20（6.09-67.01）vs.0.5%（2/339），OR=0.04(0.01-0.17))。59%的cRH患者,<24小时意识改变，惯性损伤缺乏脑缺氧的影像学证据，缺血,或肿胀。
结论：cRH与惯性角加速度力显著相关。它们可以在没有脑缺氧的情况下发生，缺血或肿胀表明它们不是继发性损伤。
目的：研究目的是确定cRH是否与惯性接触机制，是主要的vs.二次伤害。
方法：这项回顾性研究利用了一个去识别的PediBIRN数据库，该数据库包含701名3岁以下接受重症监护的头部创伤儿童。排除患有机动车相关创伤和先前存在的大脑异常的儿童。所有患者的影像学检查均显示头部受伤，并进行了专门的眼科检查。
方法：接触性损伤包括颅面软组织损伤，颅骨骨折和硬膜外血肿.惯性损伤包括急性损伤或意识丧失和/或双侧和/或半球间硬膜下出血。虐待的定义有两种，通过1）预先确定的标准和2）护理医师/多学科团队的诊断共识。
结果：患有cRH的PediBIRN受试者经常经历惯性损伤（99.4％（308/310，OR=53.74（16.91-170.77）），但很少发生孤立的接触性创伤（0.6％（2/310），OR=0.02(0.0004-0.06))。根据预定标准（99.1％（237/239），在cRH分类为AHT的儿童中，惯性损伤优先于接触性损伤，OR=20.20（6.09-67.01）vs.0.5%（2/339），OR=0.04(0.01-0.17))。59%的cRH患者,<24小时意识改变，惯性损伤缺乏脑缺氧的影像学证据，缺血,或肿胀。
结论：cRH与惯性角加速度力显著相关。它们可以在没有脑缺氧的情况下发生，缺血或肿胀表明它们不是继发性损伤。
