Published online January 3, 2005
PEDIATRICS Vol. 115 No. 1 January 2005, pp. 192 (doi:10.1542/peds.2004-1888)
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Retinal Hemorrhages in Accidental and Nonaccidental Injury

Gregg T. Lueder, MD
Departments of Ophthalmology and Visual Sciences and Pediatrics,
St Louis Children's Hospital,
Washington University School of Medicine,
St Louis, MO 63110

To the Editor.—

Bechtel et al1 are to be commended for their study regarding retinal hemorrhages in children with accidental and nonaccidental injury. Retinal findings are critically important in evaluation of these children. Although a small number of dot or blot hemorrhages may be seen occasionally in children with accidental head injury, the presence of diffuse hemorrhages almost always indicates nonaccidental injury.2 This observation is substantiated by the authors' finding of no preretinal hemorrhages, retinal hemorrhages extending to the periphery, premacular retinal hemorrhages, or vitreous hemorrhages in the accidental-injury group.

Table 4 of the article indicates that 3 of the 7 patients with accidental injuries who had retinal hemorrhages had a single hemorrhage. It would be useful if the authors could provide additional details regarding the retinal hemorrhages found in the 4 additional patients with accidental injury. Specifically, what were the mechanisms of injury in these 4 patients, how many retinal hemorrhages did they have, and what were the locations of the hemorrhages? The significance of retinal hemorrhages in children suspected of having nonaccidental injuries has sparked a heated debate in the medical literature.3 This additional information has both medical and legal importance and would be beneficial to those of us who evaluate and treat such patients.

REFERENCES

  1. Bechtel K, Stoessel K, Leventhal JM, et al. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114 :165 –168[Abstract/Free Full Text]
  2. Levin AV. Ocular manifestations of child abuse. Ophthalmol Clin North Am. 1990;3 :249 –264
  3. Lantz P. Junk science and glass houses [letter]. Pediatrics. 2004;114 :330[Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics




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