Original articleA Systematic Review of the Diagnostic Accuracy of Ocular Signs in Pediatric Abusive Head Trauma
Section snippets
Types of Studies
Studies were included that allowed conclusions to be made regarding sensitivity or specificity of ocular findings for AHT. Sensitivity can be calculated from the frequency of ocular findings in a consecutive series of patients with AHT. Specificity can be calculated from the frequency of ocular findings in consecutively recruited control groups. Thus, the types of studies eligible for inclusion were case-control studies, cohort studies, or consecutive case series.
Population
Eligible studies included
Results
The varied search terms for AHT combined with retinal hemorrhage, retinal folds, retinoschisis and optic nerve sheath hemorrhage returned a total of 971 unique articles. A total of 79 relevant articles from all search sets were reviewed in full. A further 9 articles were added from reference lists of relevant articles, making a total of 88 articles. Of these, 33 articles were excluded for various reasons (Fig 1), leaving 55 studies.
Grading was performed on all 55 eligible studies. Because we
Discussion
Since the first case report2 of retinal trauma in an abused infant, level III retrospective studies14, 17 have confirmed that a significant proportion of infants with AHT have IOH. These studies have several potential drawbacks, including incomplete data and interobserver bias. The largest retrospective series14 found that fatal cases had more severe and diffuse retinal findings extending to the periphery, whereas nonfatal cases had fewer IOH that were confined to the posterior pole.
Numerous
Clinical Recommendations
The significance of ocular findings in AHT has been the subject of great controversy. Previously identified8 weaknesses in the evidence base were the lack of prospective, controlled studies, frequency of circular logic, and inconsistency in definition of cases. Currently, there is level II evidence from prospective controlled studies, supporting a significant relationship between IOH and AHT. Accurate classification of trauma as being from abuse remains difficult, because the trauma is
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Manuscript no. 2009-103.
Financial Disclosure(s): The authors have made the following disclosures:
A/Prof Frank J. Martin – Alcon Advisory Board
This was not related to the preparation of this manuscript, and there was no conflict of interest.
Minas T. Coroneo, Gaurav Bhardwaj, Vivek Chowdhury and Mark B. Jacobs received research funding from the Sydney Children's Hospital Foundation, Randwick, NSW. No funds however were directly utilized in producing this article. The sponsor or funding organization had no role in the design or conduct of this research.