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목적 : Retinal hemorrhage (RH) is one of the hallmarks of abusive head trauma (AHT); however RH is also encountered with normal vaginal deliveries (NVD), and thus presents the clinician with a diagnostic dilemma. To further elucidate differing characteristics between the two groups, a comparison study was performed which evaluated RHs in an AHT group versus an NVD group.
방법 : Twenty patients with AHT and 200 NVD infants with retinal hemorrhages (RH) evaluated from 2013 to 2015 were included in this study. Pattern, size, extent, and severity were compared using Retcam images. Severities were calculated using the CHOP RH grading scale.
결과 : RH size was significantly larger in AHT patients compared to the NVD group (3.1 vs 0.96 DD, respectively). The AHT group also demonstrated a higher RH incidence involving all three retinal layers compared to the NVD group (60% vs 0.6%, p<0.001). Vitreous hemorrhages were encountered more commonly in the AHT group (54.3%) in comparison to the NVD group (1.5%) (p<0.001). Overall, grading demonstrated higher scores in the AHT group than the NVD group (7.15 vs 3.59, ). All patients in the AHT group demonstrated one or more other systemic findings.
결론 : AHT presented with more severe retinal findings than NVD, including larger RH size, a higher percentage involving all three retinal layers, a higher percentage of vitreous hemorrhages, and higher CHOP RH grading scale scores. Therefore, in cases wherein NVD retinal findings are more extensive than anticipated, it is important to explore other factors suggestive of AHT, such as a history of loss of consciousness, history of seizures, and epidural hemorrhages observed on neuroimaging.
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