Document Detail

A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma.
MedLine Citation:
PMID:  20347153     Owner:  NLM     Status:  MEDLINE    
TOPIC: To review systematically the diagnostic accuracy of various ocular signs for pediatric abusive head trauma (AHT).
CLINICAL RELEVANCE: Intraocular hemorrhages (IOH), perimacular retinal folds, traumatic retinoschisis and optic nerve sheath hemorrhages have been reported as cardinal signs of AHT. The evidence base supporting the accuracy of this interpretation, however, has not been systematically reviewed.
METHODS: A systematic keyword search of MEDLINE, EMBASE, and Evidence-Based Medicine Reviews was conducted for original studies reporting ocular findings in AHT. Articles were graded using a checklist for systematic reviews of diagnostic accuracy.
RESULTS: The initial search yielded 971 articles, of which 55 relevant studies were graded, and 20 studies met inclusion criteria and were included in the review. The overall sensitivity of IOH for AHT was 75% and their specificity was 94%. Intraretinal hemorrhage at the posterior pole was the most common finding, although extensive, bilateral, and multilayered IOH were the most specific for AHT. Optic nerve sheath hemorrhages had a sensitivity and specificity for AHT of 72% and 71%, respectively. Traumatic retinoschisis and perimacular retinal folds were reported in 8% and 14% of AHT, respectively, but were not reported in other conditions.
CONCLUSIONS: Prospective, consecutive studies confirm that IOH in infants-particularly bilateral, extensive, and multilayered-are highly specific for AHT. Optic nerve sheath hemorrhages are significantly more common in AHT than in other conditions, in autopsy studies. Traumatic retinoschisis and perimacular folds are present in a minority of AHT, but rarely seen in other conditions.
Gaurav Bhardwaj; Vivek Chowdhury; Mark B Jacobs; Kieran T Moran; Frank J Martin; Minas T Coroneo
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-03-27
Journal Detail:
Title:  Ophthalmology     Volume:  117     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-04     Completed Date:  2010-05-13     Revised Date:  2011-03-04    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  983-992.e17     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
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MeSH Terms
Child Abuse*
Child, Preschool
Craniocerebral Trauma / diagnosis*,  etiology
Databases, Bibliographic
Infant, Newborn
Optic Nerve Injuries / diagnosis*,  etiology
Reproducibility of Results
Retinal Hemorrhage / diagnosis*,  etiology
Retinoschisis / diagnosis*,  etiology
Sensitivity and Specificity
Comment In:
Ophthalmology. 2011 Feb;118(2):430; author reply 430-1   [PMID:  21292122 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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