title: Retinal haemorrhages in- head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age.
abstract: BACKGROUND
  Falls are a common chief complaint among children seeking medical attention in emergency departments and are the leading cause of injuries requiring hospitalisation. Falls are also a frequent excuse to conceal cases of maltreatment in small children. Retinal haemorrhages could be a useful marker for their differential diagnosis.
  
  
  OBJECTIVE
  This study aims to determine the prevalence and characteristics of retinal haemorrhages in children with head trauma resulting from a vertical fall.
  
  
  METHODS
  This was a prospective study of children younger than 2 years of age admitted to the hospital with head trauma from a vertical fall. The circumstances of the falls and injuries were analysed. All children were evaluated by an ophthalmologist for retinal haemorrhage.
  
  
  RESULTS
  One hundred fifty-four patients were included. Eighty-three percent of the falls were from a height equal to or less than 120 cm. The most common mechanism of injury was fall from a stroller followed by rolling off the bed. Sixteen children had evidence of intracranial injuries. Three patients had retinal haemorrhages (prevalence 1.9%; 95%CI, 0.4-5.6%), all unilateral, in association with severe epidural haematoma with a midline shift. The detection of retinal haemorrhages could be related to the presence of intracranial injury but not with the circumstances of the fall.
  
  
  CONCLUSIONS
  Any cranial injury from a vertical fall that produces severe epidural bleeding can also cause retinal haemorrhages, mainly unilateral. The finding of diffuse and bilateral retinal haemorrhages or their presence in the absence of this type of intracranial haemorrhage must continue to point out another cause different from the fall as origin of the traumatism, being necessary to exclude non-accidental trauma.
authors.affiliation: Department of Paediatrics, Sant Joan de Déu Hospital, University of Barcelona, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950, Barcelona, Spain. vtrenchs@hsjdbcn.org
authors.forename: V
authors.initials: V
authors.lastname: Trenchs
authors.forename: A I
authors.initials: AI
authors.lastname: Curcoy
authors.forename: M
authors.initials: M
authors.lastname: Morales
authors.forename: A
authors.initials: A
authors.lastname: Serra
authors.forename: R
authors.initials: R
authors.lastname: Navarro
authors.forename: J
authors.initials: J
authors.lastname: Pou
mesh_terms: D000058:Accidental Falls; D006259:Craniocerebral Trauma / Q000150:complications* / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D008297:Male; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology*