• Gaurav Bhardwaj, Mark B Jacobs, Frank J Martin, Kieran T Moran, Kristina Prelog, Craig Donaldson, Ute Vollmer-Conna, and Minas T Coroneo.
• Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia. Electronic address: gauravb23@gmail.com.
• J AAPOS. 2017 Feb 1; 21 (1): 28-33.e2.

BackgroundRetinal hemorrhages (RH) in babies in the absence of severe trauma or a medical cause have been strongly associated with abusive head trauma (AHT). We examined the pattern of RH in accidental head injury and AHT objectively using widefield retinal imaging.MethodsA total of 118 infants and children 1-36 months of age admitted with head injuries at two centers were included in this prospective, consecutive, comparative cohort study. Dilated fundus examination was performed with indirect ophthalmoscopy and widefield imaging. Designation of AHT was made using predetermined criteria independent of retinal findings. Retinal images were graded by two independent observers.ResultsThere were 21 cases of AHT. RH were present in 14 cases (66%); macular retinoschisis or retinal folds, in 8 (38%). There were 86 cases of accidental head injuries, with RH present in 2 (2%); there were none with retinal folds or retinoschisis. In cases of head injury with intracranial hemorrhage, the positive likelihood ratio of AHT with RH was 5.7 (95% CI, 2.6-12.00) and negative likelihood ratio was 0.26 (95% CI, 0.11-0.62). A severe, panretinal pattern with multilayered hemorrhages was the most specific for AHT.ConclusionsOur imaging study confirmed that RH in infants with head injury have a high positive likelihood ratio for AHT. A severe hemorrhagic retinopathy, particularly in association with perimacular folds or macular retinoschisis, has the highest positive predictive value for AHT.Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. All rights reserved.

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