MAY 06, 2010
This study's authors conducted a systematic literature review to determine the diagnostic accuracy of various ocular signs for pediatric abusive head trauma. The result is a comprehensive review of the signs of abusive head trauma of which all comprehensive ophthalmologists should be aware.
From the 20 studies reviewed, the overall sensitivity of intraocular hemorrhages (IOH) was 75 percent and specificity was 94 percent. Extensive, bilateral and multilatyered IOH were the most specific for abusive trauma. Optic nerve sheath hemorrhages were significantly more common in cases of abuse than in other conditions, with a sensitivity of 72 percent and specificity of 71 percent. Traumatic retinoschisis and perimacular folds are present only in a minority of cases (8 percent and 14 percent, respectively) but they are rarely seen in other conditions.
The spectrum of injury and clinical presentation in this type of abuse is broad, and less severe cases are often difficult to diagnose due to unreliability of the history, nonspecific symptoms, and lack of external signs of injury. However, the authors conclude that the diagnostic accuracy for abuse is improved when multiple pathologies, including IOH, optic nerve sheath hemorrhage and intracranial hemorrhage, are present.