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Azuma N, Yoshida T, Yokoi T, Nishina S, Uematsu S, Miyasaka M. Retinal hemorrhages and damages from tractional forces associated with infantile abusive head trauma evaluated by wide-field fundus photography. Sci Rep 2024; 14:5246. [PMID: 38438406 PMCID: PMC10912762 DOI: 10.1038/s41598-024-54664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
We evaluated the distribution and types of retinal hemorrhages (RHs) and other damages in eyes with abusive head trauma (AHT). This retrospective, consecutive case series of AHT and non-AHT conditions involved 54 children with AHT, 43 children with head bruises, and 49 children with blunt eye trauma, each of non-AHT supported by reliable witness accounts. RHs and other damage were evaluated using ophthalmoscopy and wide-field fundus photography. A variety of RH types and other damage were identified in the AHT group but not in the non-AHT group. RHs in AHT extended from the posterior pole to the far periphery in 77% of eyes and on/near the veins in 86% and arteries in 85%, most of which were in the far periphery. Retinoschisis, white-dot lesions, and retinal folds were seen even in the far periphery. RHs on/near the veins and arteries, retinoschisis, and retinal folds suggest a traumatic mechanism of the tractional force of the vitreous that is attached to the entire retinal surface. Identifying the distribution and arterio and venous origins of RHs is a key factor in determining the association with trauma. Thus, wide-field fundus photography is useful to record and evaluate the origin of the RHs and other retinal damage.
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Affiliation(s)
- Noriyuki Azuma
- Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan.
| | - Tomoyo Yoshida
- Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Yokoi
- Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
| | - Sachiko Nishina
- Division of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Mikiko Miyasaka
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan.
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Stellungnahme zur augenärztlichen Untersuchung bei Verdacht auf ein Schütteltrauma-Syndrom (STS). Klin Monbl Augenheilkd 2023; 240:1421-1426. [PMID: 38092005 DOI: 10.1055/a-2191-7019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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3
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Barth T, Stahl A, Herrmann B, Tost F, Bertram B. [Statement on ophthalmological examination for suspected shaken baby syndrome (SBS). : Statement of the German Society of Ophthalmology (DOG), the German Retina Society (RG), the German Professional Association of Ophthalmologists (BVA) in cooperation with German Society for Child Protection in Medicine (DGKiM). Status: June 2023]. DIE OPHTHALMOLOGIE 2023; 120:1233-1237. [PMID: 37773527 DOI: 10.1007/s00347-023-01921-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 10/01/2023]
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Khosravi P, Huck NA, Shahraki K, Hunter SC, Danza CN, Kim SY, Forbes BJ, Dai S, Levin AV, Binenbaum G, Chang PD, Suh DW. Deep Learning Approach for Differentiating Etiologies of Pediatric Retinal Hemorrhages: A Multicenter Study. Int J Mol Sci 2023; 24:15105. [PMID: 37894785 PMCID: PMC10606803 DOI: 10.3390/ijms242015105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Retinal hemorrhages in pediatric patients can be a diagnostic challenge for ophthalmologists. These hemorrhages can occur due to various underlying etiologies, including abusive head trauma, accidental trauma, and medical conditions. Accurate identification of the etiology is crucial for appropriate management and legal considerations. In recent years, deep learning techniques have shown promise in assisting healthcare professionals in making more accurate and timely diagnosis of a variety of disorders. We explore the potential of deep learning approaches for differentiating etiologies of pediatric retinal hemorrhages. Our study, which spanned multiple centers, analyzed 898 images, resulting in a final dataset of 597 retinal hemorrhage fundus photos categorized into medical (49.9%) and trauma (50.1%) etiologies. Deep learning models, specifically those based on ResNet and transformer architectures, were applied; FastViT-SA12, a hybrid transformer model, achieved the highest accuracy (90.55%) and area under the receiver operating characteristic curve (AUC) of 90.55%, while ResNet18 secured the highest sensitivity value (96.77%) on an independent test dataset. The study highlighted areas for optimization in artificial intelligence (AI) models specifically for pediatric retinal hemorrhages. While AI proves valuable in diagnosing these hemorrhages, the expertise of medical professionals remains irreplaceable. Collaborative efforts between AI specialists and pediatric ophthalmologists are crucial to fully harness AI's potential in diagnosing etiologies of pediatric retinal hemorrhages.
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Affiliation(s)
- Pooya Khosravi
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA 92697, USA;
| | - Nolan A. Huck
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
| | - Kourosh Shahraki
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
| | - Stephen C. Hunter
- School of Medicine, University of California, 900 University Ave, Riverside, CA 92521, USA;
| | - Clifford Neil Danza
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
| | - So Young Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan 31151, Chungcheongnam-do, Republic of Korea;
| | - Brian J. Forbes
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (B.J.F.); (G.B.)
| | - Shuan Dai
- Department of Ophthalmology, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia;
| | - Alex V. Levin
- Department of Ophthalmology, Flaum Eye Institute, Golisano Children’s Hospital, Rochester, NY 14642, USA;
| | - Gil Binenbaum
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (B.J.F.); (G.B.)
| | - Peter D. Chang
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA 92697, USA;
- Department of Radiological Sciences, School of Medicine, University of California, Irvine, CA 92697, USA
| | - Donny W. Suh
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
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Macher J, Porter RS, Levin AV. Ophthalmic imaging in abusive head trauma. CHILD ABUSE & NEGLECT 2023; 139:106106. [PMID: 36867971 DOI: 10.1016/j.chiabu.2023.106106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Ophthalmic imaging plays an increasingly important role the evaluation of abusive head trauma, however these imaging modalities may be unfamiliar to non-ophthalmologists. OBJECTIVE To provide pediatricians and child abuse pediatric professionals with background on ophthalmic imaging techniques in the context of suspected abuse, as well as information on commercial options and costs for those interested in augmenting their ophthalmic imaging capabilities. METHODS We performed a review of the ophthalmic imaging literature for fundus photography, ocular coherence tomography, fluorescein angiography, ocular ultrasound, computed tomography, magnetic resonance imaging and postmortem imaging. We also contacted individual vendors for equipment pricing information. RESULTS For each ophthalmic imaging modality, we demonstrate its role in the evaluation of abusive head trauma including indications, potential findings, sensitivity and specificity of findings for abuse, and commercial options. CONCLUSIONS Ophthalmic imaging is an important supportive component of the evaluation for abusive head trauma. When used in conjunction with clinical examination, ophthalmic imaging can improve diagnostic accuracy, support documentation, and possibly improve communication in medicolegal contexts.
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Affiliation(s)
- Jared Macher
- University of Rochester School of Medicine, Rochester, NY, USA.
| | - Randall S Porter
- Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Alex V Levin
- University of Rochester School of Medicine, Rochester, NY, USA; Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Rochester, NY, USA; Clinical Genetics, Golisano Children's Hospital, Rochester, NY, USA.
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Simon CL, Ude I, Levin MR, Alexander JL. Retinal hemorrhages in abusive head trauma with atraumatic neuroimaging. J AAPOS 2023; 27:39-42. [PMID: 36516943 PMCID: PMC9975066 DOI: 10.1016/j.jaapos.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 12/14/2022]
Abstract
We report 3 cases of suspected abusive head trauma with retinal hemorrhages on fundus examination and neuroimaging findings not necessarily suggestive of shaking injury. Previous studies have suggested that retinal hemorrhages are rare in patients without neuroimaging abnormalities. These cases demonstrate some common features (rib fractures, developmental delay, and history of abuse) that may increase suspicion for abusive head trauma. Our findings suggest a potential role for ophthalmic consultation in scenarios with high clinical suspicion for abusive head trauma without definitive neuroimaging evidence of head injury. The nonspecific neuroimaging features of these 3 cases highlight the importance of interpreting cases with global clinical context.
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Affiliation(s)
| | - Ifeoma Ude
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Moran R Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Janet L Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland.
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Corbiceiro WCH, Silva TL, Correia RS, de Vasconcelos MM, Corrêa DG. Magnetic resonance imaging features of retinal hemorrhage in abusive head trauma. Childs Nerv Syst 2022; 38:2345-2347. [PMID: 36369384 DOI: 10.1007/s00381-022-05743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Weydler Campos Hottz Corbiceiro
- Department of Radiology, Federal Fluminense University, Avenida Marquês de Paraná, 303, Centro, Niterói, RJ, 24070-035, Brazil.
| | - Thallys Leal Silva
- Department of Radiology, Federal Fluminense University, Avenida Marquês de Paraná, 303, Centro, Niterói, RJ, 24070-035, Brazil
| | - Rafael Santos Correia
- Department of Radiology, Federal Fluminense University, Avenida Marquês de Paraná, 303, Centro, Niterói, RJ, 24070-035, Brazil
| | - Marcio Moacyr de Vasconcelos
- Postgraduate Program in Neurology and Neuroscience, Federal Fluminense University, Avenida Marquês de Paraná, 303, Centro, Niterói, RJ, 24070-035, Brazil
| | - Diogo Goulart Corrêa
- Department of Radiology, Federal Fluminense University, Avenida Marquês de Paraná, 303, Centro, Niterói, RJ, 24070-035, Brazil
- Department of Radiology, Clínica de Diagnóstico Por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ, 2640-102, Brazil
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Sayrs LW, Ortiz JB, Notrica DM, Kirsch L, Kelly C, Stottlemyre R, Cohen A, Misra S, Green TR, Adelson PD, Lifshitz J, Rowe RK. Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP6785-NP6812. [PMID: 33092447 DOI: 10.1177/0886260520967151] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Over half of fatal pediatric traumatic brain injuries are estimated to be the result of physical abuse, i.e., abusive head trauma (AHT). Although intimate partner violence (IPV) is a well-established risk for child maltreatment, little is known about IPV as an associated risk factor specifically for AHT. We performed a single-institution, retrospective review of all patients (0-17 years) diagnosed at a Level 1 pediatric trauma center with head trauma who had been referred to an in-hospital child protection team for suspicion of AHT between 2010 and 2016. Data on patient demographics, hospitalization, injury, family characteristics, sociobehavioral characteristics, physical examination, laboratory findings, imaging, discharge, and forensic determination of AHT were extracted from the institution's forensic registry. Descriptive statistics (mean, median), chi-square and Mann-Whitney U tests were used to compare patients with fatal head injuries to patients with nonfatal head injuries by clinical characteristics, family characteristics, and forensic determination. Multiple logistic regression was used to estimate adjusted odds ratios for the presence of IPV as an associated risk of AHT while controlling for other clinical and family factors. Of 804 patients with suspicion for AHT in the forensic registry, there were 240 patients with a forensic determination of AHT; 42 injuries were fatal. There were 101 families with a reported history of IPV; 64.4% of patients in families with reported IPV were <12 months of age. IPV was associated with a twofold increase in the risk of AHT (Exp(β) = 2.3 [p = .02]). This study confirmed IPV was an associated risk factor for AHT in a single institution cohort of pediatric patients with both fatal and nonfatal injuries. Identifying IPV along with other family factors may improve detection and surveillance of AHT in medical settings and help reduce injury, disability, and death.
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Affiliation(s)
- Lois W Sayrs
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - J Bryce Ortiz
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - David M Notrica
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Lisa Kirsch
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Cara Kelly
- Phoenix Children's Hospital, Phoenix, AZ, USA
- Arizona State University School of Social Work, Phoenix, AZ, USA
| | | | - Aaron Cohen
- Valleywise Health Medical Center, Phoenix, AZ, USA
| | - Shivani Misra
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Tabitha R Green
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - P David Adelson
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Jonathan Lifshitz
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, USA
| | - Rachel K Rowe
- Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, AZ, USA
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, USA
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Moskwa R, Todeschi J, Wiedemann-Fode A, Stella I, Joud A, Klein O. Ophthalmological lesions in shaken baby syndrome: a retrospective analysis of 133 consecutive cases (1992-2018). Neurochirurgie 2022; 68:367-372. [PMID: 35150727 DOI: 10.1016/j.neuchi.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Shaken Baby Syndrome (SBS) is a non-accidental head trauma in which shaking causes cranio-cerebral lesions. Shaking can lead to ophthalmologic lesions such as retinal hemorrhage (RH). The aim of the present study was to compare our long-term results in to the literature data. PATIENTS AND METHODS This study was a single-center retrospective descriptive analysis of 133 consecutive SBS cases (1992 - 2018). Only seniors in ophthalmology were authorized to perform these examinations. We studied type of lesion (retinal, intra-vitreal, papilledema), location (uni- or bi-lateral), and correlation with gender and age. Infants with a traumatic context without suspicion of child abuse were excluded. RESULTS Mean age at diagnosis was 131 days (range, 14 days - 10 months). Boys accounted for 72.2% of the population. The prevalence of ophthalmologic lesions was 70.3%. 94.4% were RH; intra-vitreous hemorrhage (6.7%) and papilledema (11.1%) were less frequent. Lesions were bilateral in 81.1% of cases. Retinal lesions were classified in terms of location. Macular involvement was diagnosed in 8.2% of cases. 18.8% of retinal lesions could not be classified because of lack of precision in the ophthalmology report. The prevalence of ophthalmic lesions was higher for children aged over 6 months: 80%. CONCLUSION This series highlighted a high rate of ophthalmic lesions in SBS, with a high rate of bilateral involvement. RH was the most frequent lesion. RH in a context of subdural hematoma is a strong argument in favor of SBS. The forensic implications are that rigorous ophthalmologic examination by a senior practitioner is mandatory.
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Affiliation(s)
- Rémy Moskwa
- Department of Ophthalmology, Mercy Regional Hospital, Ars-Laquenexy, France; Service of Pediatric Neurosurgery, Children's Hospital, Nancy University Hospital, Université de Lorraine, France
| | - Julien Todeschi
- Service of Pediatric Neurosurgery, Children's Hospital, Nancy University Hospital, Université de Lorraine, France
| | - Arnaud Wiedemann-Fode
- Pediatric Intensive Care Unit, Children's Hospital, Nancy University Hospital, INSERM Unit 1256 N-GERE, Université de Lorraine, France
| | - Irene Stella
- Service of Pediatric Neurosurgery, Children's Hospital, Nancy University Hospital, Université de Lorraine, France
| | - Anthony Joud
- Service of Pediatric Neurosurgery, Children's Hospital, Nancy University Hospital, Université de Lorraine, France
| | - Olivier Klein
- Service of Pediatric Neurosurgery, Children's Hospital, Nancy University Hospital, Université de Lorraine, France.
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Ang JL, Collis S, Dhillon B, Cackett P. The Eye in Forensic Medicine: A Narrative Review. Asia Pac J Ophthalmol (Phila) 2021; 10:486-494. [PMID: 34524140 DOI: 10.1097/apo.0000000000000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
ABSTRACT The eye, with its distinctive anatomy, not only reflects a wide variety of diseases in life but also undergoes a myriad of post-mortem changes. Consequently, the eye has long been an area of interest in forensic science, primarily for the estimation of post-mortem interval and therefore the time of death and also for assistance in ascertaining the cause of death. There has been significant progress in the knowledge of ophthalmic forensic science using new technologies which have allowed further possibilities to arise where understanding of this field can assist the forensic pathologist. This review aims to highlight the current knowledge which exists in this field and also to identify important avenues for further investigation. Post-mortem changes of the eye along with its current applications and challenges will be discussed. These include the important areas of post-mortem iris biometrics, pupil size correlation with post-mortem interval, use of point-of-care technology on vitreous humor, and the use of ophthalmic imaging in pediatric abusive head trauma.
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Affiliation(s)
- Juan Lyn Ang
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - SallyAnne Collis
- Department of Forensic Pathology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Baljean Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
- The University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Cackett
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
- The University of Edinburgh, Edinburgh, United Kingdom
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Franchina M, Blaszkowska M, Lewis J, Johnson A, Clark A, Lam G, Mackey DA. Paediatric eye injuries during a COVID-19 pandemic lockdown. Clin Exp Optom 2021; 105:637-641. [PMID: 34402757 DOI: 10.1080/08164622.2021.1964921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
CLINICAL RELEVANCE Eye injuries, both accidental and non-accidental, are a significant cause of long-term visual impairment in children. An understanding of when and how such injuries occur is key to development of adequate prevention strategies. BACKGROUND To evaluate accidental and non-accidental eye injuries in children presenting to the major tertiary emergency department and outpatient ophthalmology clinic in Western Australia during the nationwide COVID-19 lockdown and to determine whether the frequency or nature of these injuries differed from pre-pandemic presentations. METHODS Retrospective review of the medical records of paediatric patients presenting to the emergency department and specialist ophthalmology clinic with an ocular injury and those presenting to the hospital Child Protection Unit with physical injuries during March-August 2020 and the same period in 2019. RESULTS There was no significant difference in the total number of accidental eye injury presentations during the lockdown period despite a significant decrease in emergency department attendance overall. Closed-globe injuries were the most common accidental eye injury presentation during lockdown (70/110, 64%), followed by adnexal injuries (39/110, 35%) and open-globe injuries (1/110, 1%). In contrast, referrals to the hospital Child Protection Unit for suspicious injuries declined during lockdown. Although eye injury presentations have changed in other parts of the world since the start of the pandemic, during COVID-19 lockdown in Western Australia, accidental paediatric ocular and adnexal trauma sustained at home continues to be a significant cause for hospital attendance. Public education regarding in-home eye injury prevention must be ongoing.
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Affiliation(s)
- Maria Franchina
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Australia
| | - Magda Blaszkowska
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Australia
| | - Joel Lewis
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Australia
| | - Alice Johnson
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Australia
| | - Antony Clark
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Australia
| | - Geoffrey Lam
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Australia
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Gjerde H, Mantagos IS. Charting the Globe: How Technologies Have Affected Our Understanding of Retinal Findings in Abusive Head Trauma/Shaken Baby Syndrome. Semin Ophthalmol 2021; 36:205-209. [PMID: 33793387 DOI: 10.1080/08820538.2021.1890150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose: Ocular findings such as retinal hemorrhages are common in abusive head trauma (AHT). Binocular indirect ophthalmoscopy has been the standard for assessing the eyes of children who are victims of AHT. However, technological advances have changed our understanding of retinal findings in AHT.Methods: Literature review on AHT - retinal findings, imaging technologies, models of representation, and telemedicine applications.Results: Many studies suggest vitreoretinal traction from repetitive acceleration-deceleration shearing forces during shaking plays an important role in the development of retinal findings in AHT. This is further supported by different imaging modalities [optical coherence tomography (OCT); magnetic resonance imaging (MRI); fluorescein angiography (FA)] and models of representation (animal and mechanical models; finite element analysis).Conclusion: Emerging technologies have augmented our diagnostic abilities, enhanced our understanding regarding the pathophysiology of retinal findings, and strengthened the link between vitreoretinal traction and ocular pathology in AHT. Telemedicine is also starting to play an important role in AHT.
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Affiliation(s)
- Harald Gjerde
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Iason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Evaluating abusive head trauma in children <5 years old: Risk factors and the importance of the social history. J Pediatr Surg 2021; 56:390-396. [PMID: 33220974 DOI: 10.1016/j.jpedsurg.2020.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Abusive head trauma (AHT) is the leading cause traumatic death in children ≤5 years of age. AHT remains seriously under-surveilled, increasing the risk of subsequent injury and death. This study assesses the clinical and social risks associated with fatal and non-fatal AHT. METHODS A single-institution, retrospective review of suspected AHT patients ≤5 years of age between 2010 and 2016 using a prospective hospital forensic registry data yielded demographic, clinical, family, psycho-social and other follow-up information. Descriptive statistics were used to look for differences between patients with AHT and accidental head trauma. Logistic regression estimated the adjusted odds ratios (AOR) for AHT. A receiver operating characteristic (ROC) curve was created to calculate model sensitivity and specificity. RESULTS Forensic evaluations of 783 children age ≤5 years with head trauma met the inclusion criteria; 25 were fatal with median[IQR] age 23[4.5-39.0] months. Of 758 non-fatal patients, age was 7[3.0-11.0] months; 59.5% male; 435 patients (57.4%) presented with a skull fracture, 403 (53.2%) with intracranial hemorrhage. Ultimately 242 (31.9%) were adjudicated AHT, 335(44.2%) were accidental, 181 (23.9%) were undetermined. Clinical factors increasing the risk of AHT included multiple fractures (Exp(β) = 9.9[p = 0.001]), bruising (Expβ = 5.7[p < 0.001]), subdural blood (Exp(β) = 5.3[p = 0.001]), seizures (Exp(β) = 4.9[p = 0.02]), lethargy/unresponsiveness (Exp(β) = 2.24[p = 0.02]), loss of consciousness (Exp(β) = 4.69[p = 0.001]), and unknown mechanism of injury (Exp(β) = 3.9[p = 0.001]); skull fracture reduced the risk of AHT by half (Exp(β) = 0.5[p = 0.011]). Social risks factors included prior police involvement (Exp(β) = 5.9[p = 0.001]), substance abuse (Exp(β) = 5.7[p = .001]), unknown number of adults in the home (Exp(β) = 4.1[p = 0.001]) and intimate partner violence (Exp(β) = 2.3[p = 0.02]). ROC area under the curve (AUC) = 0.90([95% CI = 0.86-0.93] p = .001) provides 73% sensitivity; 91% specificity. CONCLUSIONS To improve surveillance of AHT, interviews should include and consider social factors including caregiver/household substance abuse, intimate partner violence, prior police involvement and household size. An unknown number of adults in home is associated with an increased risk of AHT. STUDY TYPE/LEVEL OF EVIDENCE Prognostic, Level III.
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Barth T, Altmann M, Batzlsperger C, Jägle H, Helbig H. [Unilateral retinal hemorrhage in infants-two cases of shaken baby syndrome?]. Ophthalmologe 2020; 117:1033-1036. [PMID: 31996999 PMCID: PMC8497311 DOI: 10.1007/s00347-020-01038-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Ein 2,5 Monate alter Junge und ein 2 Monate altes Mädchen wurden wegen schwerer Bewusstseinstrübung pädiatrisch behandelt. Bei beiden Kindern fanden sich Subduralhämatome. Bei Verdacht auf nichtakzidentelles Schädel-Hirn-Trauma (NAHI) erfolgte eine Untersuchung des Augenhintergrundes, bei der sich bei beiden Säuglingen unilaterale Netzhautblutungen zeigten. Nach intensiver Differenzialdiagnostik wurde in beiden Fällen der Verdacht auf ein NAHI gestellt und eine rechtsmedizinische Begutachtung initiiert. Wichtig an dieser Fallserie ist, dass die Einseitigkeit von Netzhautblutungen ein NAHI nicht ausschließt.
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Affiliation(s)
- T Barth
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - M Altmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - C Batzlsperger
- Klinik für Kinder- und Jugendmedizin, Neonatologie, Neuropädiatrie, DONAUISAR Klinikum Deggendorf, Perlasbergerstr. 41, 94469, Deggendorf, Deutschland
| | - H Jägle
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - H Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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15
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Kim M, Kim K, Son D, Kim S. Peripapillary Subretinal Hemorrhage and Vitreous Hemorrhage after Roller Coaster Riding. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.5.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Clark A, Sinkar S, Barnes K, Lam GC, Johnson AH, Mackey DA. Non-accidental and accidental eye injuries in children in Western Australia. Clin Exp Ophthalmol 2020; 48:708-710. [PMID: 32112666 DOI: 10.1111/ceo.13741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Antony Clark
- Lions Eye Institute, Nedlands, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Child Protection Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Swati Sinkar
- Lions Eye Institute, Nedlands, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Kate Barnes
- Lions Eye Institute, Nedlands, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Geoffrey C Lam
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Child Protection Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Alice H Johnson
- Child Protection Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - David A Mackey
- Lions Eye Institute, Nedlands, Western Australia, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
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17
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Kelly JP, Feldman K, Wright J, Ganti S, Metz JB, Weiss A. Retinal and visual function in infants with non-accidental trauma and retinal hemorrhages. Doc Ophthalmol 2020; 141:111-126. [PMID: 32052259 DOI: 10.1007/s10633-020-09756-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate retinal function and visual outcomes in infants with retinal hemorrhages due to non-accidental trauma (NAT). METHODS This is a retrospective review of full-field or multifocal electroretinogram (ERG) recordings, visual acuity in log minimum angle of resolution (logMAR), clinical status, and neuroimaging. Multifocal ERGs from the central 40° were compared to corresponding fundus imaging. Visual acuity was measured by Teller cards at follow-up. ERGs were compared to controls recorded under anesthesia. RESULTS Sixteen children met inclusion criteria (14 recorded during the acute phase and 2 during long-term follow-up). During the acute phase, ERGs (n = 4 full field; n = 10 multifocal ERG) showed abnormal amplitude, latency, or both in at least one eye. Ten subjects had significantly reduced responses in both eyes, 3 of which had an ERG dominated by a negative waveform (absent b-wave or P1). The remaining six subjects had responses in one eye that were near normal (≥ 50% of controls). ERGs were sometimes abnormal in local areas without hemorrhage. ERGs could be preserved in local areas adjacent to traumatic retinoschisis. Two subjects with reduced visual acuity had belated ERGs: One had an abnormal macular ERG and the other had a normal macular ERG implying cortical visual impairment. At follow-up, 10 of 14 subjects had significant visual acuity loss (≥ 0.7 age-corrected logMAR); four subjects had mild vision loss (≤ 0.5 age-corrected logMAR). Visual acuity outcome was not reliably associated with the fundus appearance in the acute phase. All subjects with a negative ERG waveform had severe vision loss on follow-up. CONCLUSIONS Retinal dysfunction was common during the acute phase of NAT. A near normal appearing fundus did not imply normal retinal function, and ERG abnormality did not always predict a poor visual acuity outcome. However, a negative ERG waveform was associated severe visual acuity loss. Potential artifacts of retinal hemorrhages and anesthesia could not fully account for multifocal ERG abnormalities. Retinal function can be preserved in areas adjacent to traumatic retinoschisis.
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Affiliation(s)
- John P Kelly
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, OA.5.342, Seattle, WA, 98105, USA.
- Department of Ophthalmology, University of Washington, Seattle, USA.
| | - Kenneth Feldman
- Seattle Children's Hospital, Children's Protection Program, Seattle, USA
- Division of General Pediatrics, University of Washington, Seattle, USA
| | - Jason Wright
- Division of Radiology, Seattle Children's Hospital, Seattle, USA
| | - Sheila Ganti
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, USA
| | - James B Metz
- Department of Pediatrics, University of Vermont, Burlington, USA
| | - Avery Weiss
- Department of Ophthalmology, University of Washington, Seattle, USA
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18
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Gimaldinova NE, Ignatyeva EN, Lubovceva LA, Vorobyeva OV. [Pathomorphological features of baby shaking syndrome]. Sud Med Ekspert 2020; 63:19-22. [PMID: 32597606 DOI: 10.17116/sudmed20206303119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of study is to identify pathomorphological changes of the Central nervous system in childhood with rarely diagnosed of «baby shaking» syndrome on the example of sectional case. The analysis of medical documentation (medical history and outpatient card of the child) was done. The standard method of opening the skull cavity of infants was used. Histological cuts of autopsy material were treated with hematoxilin-eosin coloring. The relationship of clinical and morphological manifestations of this pathology with anatomical and physiological features of the structure of the Central nervous system and its blood supply in children was stated. We describe in details the characteristic pathomorphological changes in the brain in childhood that occur with this syndrome. Dark red «flattened» blood coagulations of subtentorial localization and in the left convexital region were visualized in the cranial cavity. We paid attention to the presence of numerous bridge veins of the brain, flowing into the sagittal sinus (frontal and parietal) and the transverse sinus.
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Affiliation(s)
- N E Gimaldinova
- Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
| | - E N Ignatyeva
- Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
| | - L A Lubovceva
- Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
| | - O V Vorobyeva
- Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
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19
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Welson NN, Mohamed YA. Awareness of different forms of child abuse among Beni Suef University students: descriptive survey. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2019. [DOI: 10.1186/s41935-019-0174-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Child abuse is a worldwide phenomenon that can cause intense long-term aftereffects.
Aim
To evaluate the awareness of Beni Suef University students about different forms of child abuse as well as the size, causes, and complications of this problem in our society and determine the prevalence of physical child abuse.
Methods
The study included 1688 students from health science and non-health science colleges of Beni Suef University, Egypt. The study participants were asked to answer a questionnaire of two parts. The first part included questions about demographic data and personal experience of child abuse, and the second part included questions about opinions of participants on child abuse to assess their awareness and if there was any difference in the level of awareness between students of health science colleges and those of non-health science colleges.
Results
Health science college students were more life satisfied and felt more loved. Only 28.91% of the included students were not exposed to child abuse, while 12.59% of them suffered from wounds or fractures as a result of the abuse they were exposed to. About one third of the students thought that the commonest form of child abuse is verbal punishment such as threatening or humiliation and that the age at the greatest risk for abuse was the primary school age. About 68.36% of students thought that sexual abuse is a huge problem in our society. Only 21.56% of students disapproved child corporal punishment. More than half of the students stated that the most dangerous complication of child abuse is psychological problems such as depression. Most of the included students would talk to the child’s parents and advise them if they saw a case of abuse, while the least would call the police. Only half of the students disapproved female genital mutilation (FGM). The strongest predictive factors for FGM approval were rural residence and male sex. Students mainly thought that FGM is a social habit that is carried out for ethical causes. About half of the students approved legal punishment by the court for FGM performers.
Conclusion
A significant proportion of the students experienced physical child abuse which left no injuries in most cases; males and first academic year students show more exposure to abuse. Moreover, most of the students think that child corporal punishment can be allowed although about half of them think that the most dangerous aftereffect of child abuse is psychological problems. Lack of reporting the exposure to child abuse is explained by the largest percentage of students to be due to lack of awareness. Rural resident males show more approval of female genital mutilation. A significant lack of awareness about FGM complications is observed in both groups (the health science and non-health science college groups) and the opinions of both groups are very close.
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20
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Wester K. Two Infant Boys Misdiagnosed as "Shaken Baby" and Their Twin Sisters: A Cautionary Tale. Pediatr Neurol 2019; 97:3-11. [PMID: 31147228 DOI: 10.1016/j.pediatrneurol.2019.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/06/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Knut Wester
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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21
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22
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Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK, Moreno JA, Dias MS, Christian CW, Nelson MD, Silvera VM, Palasis S, Raissaki M, Rossi A, Offiah AC. Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 2018; 48:1048-1065. [PMID: 29796797 DOI: 10.1007/s00247-018-4149-1] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/22/2018] [Accepted: 04/25/2018] [Indexed: 01/01/2023]
Abstract
Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.
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Affiliation(s)
- Arabinda Kumar Choudhary
- Department of Radiology, Nemours AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sabah Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas L Slovis
- Department of Radiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
| | | | - Gary L Hedlund
- Department of Medical Imaging, Primary Children's Hospital, Intermountain Healthcare, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sandeep K Narang
- Division of Child Abuse Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Mark S Dias
- Departments of Neurosurgery and Pediatrics, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Cindy W Christian
- Department of Pediatrics, Child Abuse and Neglect Prevention, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Marvin D Nelson
- Department of Radiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | - Susan Palasis
- Pediatric Neuroradiology, Children's Healthcare of Atlanta, Scottish Rite Campus, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Raissaki
- Department of Radiology, University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Amaka C Offiah
- Paediatric Musculoskeletal Imaging, Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, Western Bank, University of Sheffield, Sheffield, UK
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23
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Wang G, Zhang YP, Gao Z, Shields LBE, Li F, Chu T, Lv H, Moriarty T, Xu XM, Yang X, Shields CB, Cai J. Pathophysiological and behavioral deficits in developing mice following rotational acceleration-deceleration traumatic brain injury. Dis Model Mech 2018; 11:dmm030387. [PMID: 29208736 PMCID: PMC5818073 DOI: 10.1242/dmm.030387] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/16/2017] [Indexed: 01/22/2023] Open
Abstract
Abusive head trauma (AHT) is the leading cause of death from trauma in infants and young children. An AHT animal model was developed on 12-day-old mice subjected to 90° head extension-flexion sagittal shaking repeated 30, 60, 80 and 100 times. The mortality and time until return of consciousness were dependent on the number of repeats and severity of the injury. Following 60 episodes of repeated head shakings, the pups demonstrated apnea and/or bradycardia immediately after injury. Acute oxygen desaturation was observed by pulse oximetry during respiratory and cardiac suppression. The cerebral blood perfusion was assessed by laser speckle contrast analysis (LASCA) using a PeriCam PSI system. There was a severe reduction in cerebral blood perfusion immediately after the trauma that did not significantly improve within 24 h. The injured mice began to experience reversible sensorimotor function at 9 days postinjury (dpi), which had completely recovered at 28 dpi. However, cognitive deficits and anxiety-like behavior remained. Subdural/subarachnoid hemorrhage, damage to the brain-blood barrier and parenchymal edema were found in all pups subjected to 60 insults. Proinflammatory response and reactive gliosis were upregulated at 3 dpi. Degenerated neurons were found in the cerebral cortex and olfactory tubercles at 30 dpi. This mouse model of repetitive brain injury by rotational head acceleration-deceleration partially mimics the major pathophysiological and behavioral events that occur in children with AHT. The resultant hypoxia/ischemia suggests a potential mechanism underlying the secondary rotational acceleration-deceleration-induced brain injury in developing mice.
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Affiliation(s)
- Guoxiang Wang
- Department of Spine Surgery, Orthopedics Hospital affiliated to the Second Bethune Hospital, Jilin University, Changchun 130041, China
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
| | - Zhongwen Gao
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
| | - Fang Li
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Neurological Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Tianci Chu
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Huayi Lv
- Eye Center of the Second Bethune Hospital, Jilin University, Changchun 130041, China
| | - Thomas Moriarty
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
| | - Xiao-Ming Xu
- Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Xiaoyu Yang
- Department of Spine Surgery, Orthopedics Hospital affiliated to the Second Bethune Hospital, Jilin University, Changchun 130041, China
| | - Christopher B Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, USA
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Jun Cai
- Department of Spine Surgery, Orthopedics Hospital affiliated to the Second Bethune Hospital, Jilin University, Changchun 130041, China
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
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24
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Chong CF, Misra SL, Escardo-Paton JA, Dai S. Predictors of long-term neurological outcomes in non-accidental head injury. Eye (Lond) 2017; 32:608-614. [PMID: 29219962 DOI: 10.1038/eye.2017.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/25/2017] [Indexed: 11/09/2022] Open
Abstract
BackgroundNon-accidental head injury (NAI) is an inflicted injury usually on a child, often resulting in long-term neurological impairment and occasionally death. This study aimed to investigate the predictive values of acute findings, especially ocular, for long-term neurological outcomes.MethodsMedical records including retinal images of all children who attended the local Children's hospital with a diagnosis of NAI from over a period of 5 years were reviewed and data collected via the electronic patient record system. Patient demographics, injuries sustained, wide-field digital retinal images, visual acuity and sequalae, neurological function, and global function was noted. IBM SPSS software program was used for statistical analysis.ResultsOf the 38 patients (24 males, 14 females), 12 children died acutely from the head injury with the remaining 26 children available for long-term follow-up. A younger age of injury (P=0.004) was the only statistically significant predictor of good neurological outcome as compared with absence of macular retinoschisis, unilateral retinal haemorrhage, and unilateral subdural haemorrhage. Of the 38 children, 17 children had retinoschisis; 9 children with macular retinoschisis died acutely while 4 suffered a degree of developmental delay and only 4 were developmentally normal at the last follow-up. Long-term visual acuity data was available for 18 of the 26 survivors (range: NPL to Snellen 6/5). A statistical significance was noted between retinoschisis and worsened visual acuity (P<0.05).ConclusionsBilateral macular retinoschisis on acute presentation of NAI is associated with a seven-fold and unilateral with a four-fold increase in the development of a poor neurological outcome and eventual death. Conflicting to other studies, younger children presented better neurological outcomes.
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Affiliation(s)
- C F Chong
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand.,Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - S Dai
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand.,Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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25
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Apparent Diffusion Coefficient (ADC) of the vitreous humor and Susceptibility Weighted Imaging (SWI) of the retina in abused children with retinal hemorrhages. Clin Imaging 2017; 44:38-41. [PMID: 28399448 DOI: 10.1016/j.clinimag.2017.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 03/07/2017] [Accepted: 03/22/2017] [Indexed: 11/21/2022]
Abstract
This study speculated that the apparent diffusion coefficient (ADC) of the vitreous humor might be altered in the setting of abusive head trauma (AHT) with retinal hemorrhages (RH). Fourty-four subjects were analyzed (n=20 AHT cases; n=24 controls). There was no statistically significant difference in normalized ADC values between the cases and controls (-0.14 and -0.08 respectively, p=0.46), but analysis of RH by susceptibility weighted imaging (SWI) compared to dilated funduscopic exam demonstrated statistically significant correlation (p=0.003 and 0.012). Our results suggest that SWI serves as a more sensitive diagnostic tool for detection of ocular injury in AHT than ADC.
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26
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Bhardwaj G, Jacobs MB, Martin FJ, Moran KT, Prelog K, Donaldson C, Vollmer-Conna U, Coroneo MT. Photographic assessment of retinal hemorrhages in infant head injury: the Childhood Hemorrhagic Retinopathy Study. J AAPOS 2017; 21:28-33.e2. [PMID: 28104500 DOI: 10.1016/j.jaapos.2016.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/09/2016] [Accepted: 11/19/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Retinal 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. METHODS A 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. RESULTS There 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. CONCLUSIONS Our 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.
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Affiliation(s)
- Gaurav Bhardwaj
- Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia.
| | - Mark B Jacobs
- Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia; Department of Ophthalmology, Prince of Wales and Sydney Children's Hospital, Randwick, NSW, Australia
| | - Frank J Martin
- Department of Ophthalmology, Prince of Wales and Sydney Children's Hospital, Randwick, NSW, Australia; Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, NSW, Australia; Faculty of Medicine, University of Sydney, NSW, Australia
| | - Kieran T Moran
- Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia; Child Protection Unit, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Kristina Prelog
- Department of Radiology, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Craig Donaldson
- Department of Ophthalmology, Prince of Wales and Sydney Children's Hospital, Randwick, NSW, Australia; Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Ute Vollmer-Conna
- School of Psychiatry, Faculty of Medicine, University of New South Wales (UNSW), Randwick, NSW, Australia
| | - Minas T Coroneo
- Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia; Department of Ophthalmology, Prince of Wales and Sydney Children's Hospital, Randwick, NSW, Australia
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27
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Bais B, Karst WA, Kubat B, Verdijk RM. Persistent Retinal Iron in Abusive Head Trauma. J Forensic Sci 2016; 61:1693-1696. [DOI: 10.1111/1556-4029.13215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 02/02/2016] [Accepted: 02/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Babette Bais
- Department of Forensic Medicine; Netherlands Forensic Institute; The Hague The Netherlands
| | - Wouter A. Karst
- Department of Forensic Medicine; Netherlands Forensic Institute; The Hague The Netherlands
| | - Bela Kubat
- Department of Forensic Medicine; Netherlands Forensic Institute; The Hague The Netherlands
| | - Robert M. Verdijk
- Department of Pathology; Section Ophthalmic Pathology; Erasmus MC University Medical Center; Rotterdam The Netherlands
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28
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Abstract
Shaken Baby Syndrome occurs in infants as a result of the brain pushing against the skull due to severe acceleration-deceleration forces. Symptoms of Shaken Baby Syndrome include subdural, subarachnoid, and retinal hemorrhages. MRI and ocular examinations are used to determine the extent of mental and visual damage and β-amyloid precursor protein immunohistochemical staining is used to detect axonal injuries. Surgeries such as Subdural hemorrhage (SDH) evacuation surgery and the Burr hole craniotomy are used to treat Shaken Baby Syndrome; however, the prognosis is poor in many cases. Because of the severity of Shaken Baby Syndrome and its traumatic and sometimes fatal effects, it is important to educate new parents, nurses, and doctors on the syndrome in order to prevent incidents.
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Affiliation(s)
- Maha Mian
- 1SUNY Stony Brook, Physiology and Biophysics, Stony Brook , New York , USA
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Abstract
PURPOSES OF REVIEW This article provides an update on abusive head trauma (AHT), focusing on new developments most salient to the emergency medicine clinician, including epidemiology, clinical recognition, diagnostic work-up, management of neurologic injury, and public health implications. RECENT FINDINGS The recent literature has focused on honing the clinician's ability to recognize AHT and its immediate sequelae, to more accurately distinguish between abusive and accidental head injuries by patterns of neuroimaging and retinal hemorrhages, and to appreciate the long-term impacts. Specifically, both a clinical prediction rule and biomarker show promise, and new research advocates for the early identification of subclinical seizures as well as cervical spine injuries. SUMMARY The emergency medicine provider must be able to recognize and manage children who may have AHT and to appreciate when the diagnostic findings warrant consultation with a child protection team. These authors summarize the recent and notable advances in our understanding of AHT.
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Nishimoto H. Recent progress and future issues in the management of abusive head trauma. Neurol Med Chir (Tokyo) 2015; 55:296-304. [PMID: 25797781 PMCID: PMC4628176 DOI: 10.2176/nmc.ra.2014-0349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Head trauma is the leading cause of death in child abuse cases and one of the important issues in the care of abused children. Since the Child Abuse Prevention Law was enforced in 2000 in Japan, various measures have been taken to prevent child abuse over the following decade. Accordingly, medical research on abusive head trauma (AHT) has advanced, leading to significant progress in the medical diagnosis of AHT. This progress has been brought about by (1) the widespread establishment of child protection teams (CPTs) at core hospitals, (2) the progress in neuroradiological imaging and ophthalmoscopic technologies, and (3) the introduction of postmortem imaging. However, the pathological condition of patients with AHT, particularly that of the diffuse brain swelling type, still remains poorly understood. As a result, no clear treatment strategies for AHT have been developed and no treatment outcomes have been improved to date. The development of new treatment strategies for AHT and the construction of a comprehensive database that supports clinical studies are required in the future.
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Affiliation(s)
- Hiroshi Nishimoto
- Department of Neurosurgery, Saitama Children's Medical Center, Iwatsuki, 2. Department of Neurosurgery, Kasukabe Municipital Hospital, Kasukabe, Saitama, Japan
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Alzahrani M, Ratelle J, Cavel O, Laberge-Malo M, Saliba I. Hearing loss in the shaken baby syndrome. Int J Pediatr Otorhinolaryngol 2014; 78:804-6. [PMID: 24646684 DOI: 10.1016/j.ijporl.2014.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate hearing in children diagnosed with shaken baby syndrome. METHODS A retrospective study conducted in a pediatric tertiary care center between 2006 and 2012. Children diagnosed with shaken baby syndrome were included for hearing evaluation by conventional audiometry, distortion product otoacoustic emissions and auditory brainstem responses. RESULTS Twenty-eight children were included (22 boys and 6 girls). The mean age of children at presentation was 8 months (range 1-26 months) and the mean delay before audiometric evaluation was 30 months (range 1-87 months). One child was diagnosed as having a moderate sensorineural hearing loss. The tympanic membrane mobility was normal (type A) for both ears in 22 children, one child had a reduced tympanic mobility in one ear, two children had a negative pressure, one child had a functional trans-tympanic tube and test was not performed in 2 patients. CONCLUSION This is the first study reporting hearing loss as a possible result of shaken baby syndrome. However, further studies with larger number of children would be preferable. We recommend hearing evaluation for these children to rule out hearing loss.
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Affiliation(s)
- Musaed Alzahrani
- Division of Otorhinolaryngology, University of Montreal, Montreal, QC, Canada
| | - Justine Ratelle
- Department of Audiology, Sainte-Justine University Hospital, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5, Canada
| | - Oren Cavel
- Division of Otorhinolaryngology, University of Montreal, Montreal, QC, Canada
| | - Marie Laberge-Malo
- Department of Pediatrics, Sainte-Justine University Hospital (CHUSJ), 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5, Canada
| | - Issam Saliba
- Division of Otorhinolaryngology Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHUSJ) and University of Montreal Hospital Center (CHUM), Montreal, QC, Canada.
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Moisseiev E, Dotan G. Negative g-Force Ocular Trauma Caused by a Rapidly Spinning Carousel. Case Rep Ophthalmol 2013; 4:180-3. [PMID: 24403901 PMCID: PMC3884183 DOI: 10.1159/000355416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We present a case of a 10-year-old boy who presented with bilateral diffuse subconjunctival hemorrhages after spinning rapidly on a carousel attached to an electrical scooter. We present his clinical course and discuss the physics and pathophysiology of this unique mechanism of ocular trauma.
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Affiliation(s)
- Elad Moisseiev
- *Elad Moisseiev, MD, Department of Ophthalmology, Tel Aviv Medical Center, Weitzman 6 Street, Tel Aviv 64239 (Israel), E-Mail
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Characteristics of shaken baby syndrome in a regional Japanese children's hospital. Jpn J Ophthalmol 2013; 57:568-72. [PMID: 23881041 DOI: 10.1007/s10384-013-0264-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the characteristics of Japanese shaken baby syndrome (SBS) in a regional Japanese children's hospital and verify previously reported idiosyncratic features that differ from those of SBS in Western countries: (1) a considerably higher frequency of mothers as perpetrators, (2) older ages of abusive parents, and (3) a higher rate of premature infant birth. METHODS We reviewed medical charts obtained between 2002 and 2012 at Nagano Children's Hospital, Japan. RESULTS Thirty-seven SBS cases with abusive head trauma were found, among which 11 (30 %) of the perpetrators were mothers, 9 (24 %) fathers, 3 (8 %) brothers, and 14 (37 %) involved both parents. A history of premature birth was present in 2 (5 %) of the cases. The mean age of the mother was 32.4 years and that of the father was 31.3 years. CONCLUSION The clinical characteristics of Japanese SBS in this study are largely comparable to those seen in Western countries. Compared with the previously reported idiosyncratic features, there was a decreased predominance of mothers as perpetrators of SBS, suggestive of an increasing culpability of fathers. We also noticed that the ratio of premature births was more similar to those seen in Western surveys, while the mean ages of abusive Japanese parents remained older. Such varying results warrant a further nationwide survey.
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Abstract
OBJECTIVE The objectives of this study were to provide population-based incidence estimate of abusive head trauma (AHT) in children aged 0 to 5 years from inpatient and emergency department (ED) and identify risk characteristics for recognizing high-risk children to improve public health surveillance. METHODS This was a retrospective cohort study based on children's first encounter in ED or hospital admission with a diagnosis of head trauma (HT), 2000-2010. The relationship between clinical markers and AHT was examined controlling for covariables in the model using Cox hazards regression. Kaplan-Meier incidence probability was plotted, and the number of weeks elapsing from date of birth to the first encounter with HT established the survival time (T). RESULTS Twenty-six thousand six hundred eighty-one children had HT, 502 (1.8%) resulted from abuse; 42.4% was captured from ED. Incidence varied from 28.9 (95% confidence interval [CI], 27.9-37.4) in infants to 4.1 (95% CI, 2.4-5.7) in 5-year-olds per 100,000 per year. Adjusted hazard ratio was 20.3 (95% CI, 10.9-38.0) for intracranial bleeding and 11.4 (95% CI, 8.57-15.21) for retinal hemorrhage. CONCLUSIONS Incidence estimates of AHT are incomplete without including ED. Intracranial bleeding is a cardinal feature of AHT to be considered in case ascertainment to improve public health surveillance.
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Indirect Traumas Affecting The Posterior Segment. Clin Ophthalmol 2012; 52:167-80. [DOI: 10.1097/iio.0b013e31823bbc64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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A case for an in utero etiology of chronic SDH/effusion of infancy. J Perinatol 2012; 32:79-81. [PMID: 22202958 DOI: 10.1038/jp.2011.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Imaging of Neonatal Child Abuse with an Emphasis on Abusive Head Trauma. Magn Reson Imaging Clin N Am 2011; 19:791-812; viii. [DOI: 10.1016/j.mric.2011.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bibliography. Obstetric and gynaecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2011; 24:354-6. [PMID: 21637164 DOI: 10.1097/aco.0b013e328347b491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gerth-Kahlert C, Grisanti S, Berger E, Höhn R, Witt G, Jung U. Bilateral vitreous hemorrhage in a newborn with Stickler syndrome associated with a novel COL2A1 mutation. J AAPOS 2011; 15:311-3. [PMID: 21777803 DOI: 10.1016/j.jaapos.2011.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 03/08/2011] [Accepted: 03/08/2011] [Indexed: 11/25/2022]
Abstract
Bilateral preretinal and vitreous hemorrhages in infants are rare and can present a diagnostic challenge, with nonaccidental trauma included in the differential diagnosis. We present the case of a 4-week-old boy in which a Pierre Robin sequence and a positive family history led to the clinical diagnosis of Stickler syndrome, which was confirmed by the identification of a disease-causing novel deletion of 2 nucleotides in the COL2A1 gene. This early association with Stickler syndrome has not been described previously.
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Gole G. Retinal haemorrhages in infants, abusive head trauma and the ophthalmologist. Clin Exp Ophthalmol 2010; 38:435-6. [DOI: 10.1111/j.1442-9071.2010.02339.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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