A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma
| Autor: | Frank Martin, Minas T. Coroneo, Vivek Chowdhury, Kieran T. Moran, Mark B. Jacobs, Gaurav Bhardwaj |
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| Rok vydání: | 2009 |
| Předmět: |
Child abuse
medicine.medical_specialty Retinoschisis Posterior pole MEDLINE Autopsy Sensitivity and Specificity Head trauma Ophthalmology medicine Craniocerebral Trauma Humans Clinical significance Child Abuse business.industry Infant Newborn Infant Reproducibility of Results Retinal Hemorrhage medicine.disease Databases Bibliographic Systematic review Child Preschool Optic Nerve Injuries business |
| Zdroj: | Ophthalmology. 117(5) |
| ISSN: | 1549-4713 |
| Popis: | 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. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. |
| Databáze: | OpenAIRE |
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