PEDIATRICS Vol. 115 No. 1 January 2005, pp. 192 (doi:10.1542/peds.2004-2150)
Retinal Hemorrhages in Accidental and Nonaccidental Injury: In Reply
Kirsten Bechtel, MDKathleen Stoessel, MD
John Leventhal, MD
Charles Duncan, MD
Yale University School of Medicine,
New Haven, CT 06504
We thank Dr Lueder for his comments regarding our article.1 The types of retinal hemorrhages seen in the 7 children in our study with accidental head injury, along with the mechanism of injury and type of brain injury, are as shown below:
- 1-month-old: witnessed 3-foot fall out of father's arms as he was lying in bed; acute right epidural hemorrhage and skull fracture; right single intraretinal hemorrhage
- 4-month-old: fell 3 feet out of sibling's arms; skull fracture: left intraretinal hemorrhages in the center of the retina, not extending to the periphery
- 4-month-old: witnessed 4-foot fall out of mother's arms; head hit table; acute right intracranial hemorrhage and skull fracture; right intraretinal hemorrhages around optic disk and arcades
- 8-month-old: witnessed 2-foot fall out of mother's arms as she was lying on a couch; acute left epidural hemorrhage and skull fracture; left single intraretinal hemorrhage
- 8-month-old: witnessed 3-foot fall off a bed; acute right subdural hemorrhage; bilateral intraretinal hemorrhages, each of which were small, in the center of the retina, and did not extend to the periphery
- 9-month-old: witnessed fall downstairs in walker; acute right subdural hemorrhage and right frontal skull fracture; right single intraretinal hemorrhage
- 10-month-old: crawling in driveway, head run over by car backing out, witnessed by other adults; intracranial air with orbital fracture; left intraretinal hemorrhages in the center of the retina not extending to the periphery
We appreciate the controversy that exists regarding the diagnosis of abusive head injury in young infants to which Dr Lueder alludes. It is important to note that in the cases of accidental head injury that were accompanied by retinal hemorrhages, there was a clear history of head trauma that was given by the caregivers when the child first presented for care. It is also noteworthy that the types of retinal hemorrhages present in children with accidental head injury were distinctly different from those present in children with abusive head injury in that they were confined to the intraretinal layer, did not cover the macula, and did not extend to the periphery of the retina. We hope that our study serves to clarify some of the clinical issues that are raised when evaluating young children with head trauma.
REFERENCE
- 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]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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