Intracranial findings associated with low odds of retinal hemorrhage among children under 2 years of age at a single pediatric trauma center.

Abstract

Background: Evaluation by a pediatric ophthalmologist to look for retinal hemorrhages (RH) is often part of screening for occult injury among young children with intracranial hemorrhage (ICH) presenting to a trauma center. While important, this examination may lengthen the time a child and family remain at the hospital.

Objective: We sought to identify injury patterns associated with a low likelihood of RH, which may help streamline child abuse screening protocols for very young children with ICH.

Methods, participants and setting: We conducted a retrospective cohort study of all children at a single Pediatric Level I Trauma Center who were <24 months of age, had ICH diagnosed between January 1, 2016, and June 30, 2021, and had a complete fundoscopic examination by a pediatric ophthalmologist.

Results: Of 177 children evaluated, 20 % had retinal hemorrhages. Odds of RH were very low among children with a single ICH directly underlying a skull fracture (uOR 0.05; 95 % CI 0.01-0.35), or with a single epidural hemorrhage (uOR 0.11; 95 % CI 0.01-0.84), compared to those with other intracranial injury patterns. Only one case in each group had RH: it was the same child, and the RH did not have the characteristics typically associated with abusive head trauma (AHT).

Conclusions: A dilated fundoscopic examination by a pediatric ophthalmologist may not be necessary in children <2 years of age with a single intracranial bleed directly below a skull fracture, or a single epidural hemorrhage, when there are no additional indicators of elevated AHT risk.

Level of evidence: Prognostic and Epidemiological; Level III.