title: Retinal hemorrhages and shaken baby syndrome: an evidence-based review.
abstract: BACKGROUND
  Among the causes of non-accidental head injury (NAHI), shaken baby syndrome (SBS) is difficult to diagnose and is associated with retinal hemorrhages (RH).
  
  
  METHODS
  To identify findings and patterns of RH specific to SBS, a PubMed search using the keywords "shaken baby syndrome" or "child abuse" and "retinal hemorrhage" was conducted; 66 articles met the inclusion criteria. The published data address the utility of RH in three categories: 1) in diagnosing SBS; 2) as correlated to intracranial pathology; and 3) in prognosticating SBS. The present review aimed to summarize studies in a way that facilitates clinical decision-making.
  
  
  RESULTS
  Studies found a 53-80% incidence of RH with abusive head injury and a 0-10% incidence with proven severe accidental trauma. RHs are found bilaterally 62.5-100% of the time in SBS cases, and flame-shaped hemorrhages are the most common. The incidence of RH from convulsions, chest compressions, forceful vomiting, and severe persistent coughing in the absence of another condition known to cause RH is 0.7%, 0-2.3%, 0%, and 0%, respectively.
  
  
  CONCLUSIONS
  SBS remains a difficult cause of NAHI to diagnose. Ophthalmologic examination can provide critical diagnostic and prognostic information in cases of suspected SBS. Child abuse should be highly suspect in children with RH and a parental explanation of accidental head injury, especially if the RHs are found to be bilateral, flame-shaped, or to extend through to all layers of the retina.
authors.affiliation: Center for Pediatric Surgical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Togioka
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Arnold
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Bathurst
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ziegfeld
authors.forename: Rosemary
authors.initials: R
authors.lastname: Nabaweesi
authors.forename: Paul M
authors.initials: PM
authors.lastname: Colombani
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011379:Prognosis; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D038642:Shaken Baby Syndrome / Q000175:diagnosis*