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ARTICLE: Kirsten Bechtel, Kathleen Stoessel, John M. Leventhal, Eileen Ogle, Barbara Teague, Sylvia Lavietes, Bruna Banyas, Karin Allen, James Dziura, and Charles Duncan Characteristics That Distinguish Accidental From Abusive Injury in Hospitalized Young Children With Head Trauma Pediatrics 2004; 114: 165-168 [Abstract] [Full text] [PDF]

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Retinal hemorrhages as a distinctive feature between abusive and accidental head trauma in children

Veit Sturm   (23 June 2008)

Retinal hemorrhages as a distinctive feature between abusive and accidental head trauma in children 23 June 2008
Veit Sturm, MD Department of Ophthalmology, University Hospital of Zurich Send letter to journal: Re: Retinal hemorrhages as a distinctive feature between abusive and accidental head trauma in children veit.sturm{at}usz.ch Veit Sturm	Retinal hemorrhages as a distinctive feature between abusive and accidental head trauma in children I enjoyed the recent study in which Bechtel et al1 reported characteristics that might help to distinguish accidental from abusive head trauma in young children. Their prospective study added more evidence that there are differences between the retinal hemorrhages in accidental trauma and those in victims of non-accidental trauma. Retinal hemorrhages can occur, although uncommon, in accidental major head trauma.2-4 They are often relatively mild, isolated to the posterior pole and unilateral. Retinal hemorrhages seen in non-accidental trauma are usually more severe. They tend to occur bilaterally, to involve all layers of the retina and to extend out to the ora serrata. Even vitreous hemorrhage, traumatic retinoschisis and perimacular folds can occur. The purpose of this letter is not to critique this excellent study, but to correct inaccurate statements. The authors misstate that Johnson et al5 found that of 200 children with intracranial hemorrhage or skull fractures due to accidental causes, none had retinal hemorrhages. In fact, they reported two children with retinal hemorrhages due to severe head injuries sustained in side or lateral impact crashes. Furthermore, the authors assert that Christian et al6 reported a series of four cases of young children with accidental head trauma and subdural hemorrhage who had unilateral retinal hemorrhages. In the original article only three children were identified with unilateral retinal hemorrhages caused by accidental household trauma. 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 2.Buys YM, Levin AV, Enzenauer RW, et al. Retinal findings after head trauma in infants and young children. Ophthalmology. 1992;99:1718-1723 3.Schloff S, Mullaney PB, Armstrong DC, et al. Retinal findings in children with intracranial hemorrhage. Ophthalmology. 2002;109:1472-1476 4.Gnanaraj L, Gilliland MGF, Yahya RR, et al. Ocular manifestations of crush head injury in children eye. Eye. 2007;21:5-10 5.Johnson DL, Braun D, Friendly D. Accidental head trauma and retinal hemorrhage. Neurosurgery. 1993;33:231-234 6.Christian CW, Taylor AA, Hertle RW, Duhaime AC. Retinal hemorrhages caused by accidental household trauma. J Pediatr. 1999;135:125-127 Conflict of Interest: None declared