title: Retinal hemorrhages in low-risk children evaluated for physical abuse.
abstract: OBJECTIVE
  To describe the prevalence of retinal hemorrhage (RH) in children without intracranial injury who are being evaluated for abusive head trauma and to validate previously derived criteria for identifying patients within this population who are at low risk of having RH on dilated eye examination.
  
  
  METHODS
  Medical record review.
  
  
  METHODS
  Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center from January 1, 2006, to April 30, 2010.
  
  
  METHODS
  One hundred ninety-four infants and children evaluated for physical abuse by the hospital Child Protection Team who did not have intracranial injury and who underwent a dilated eye examination to evaluate for RH.
  
  
  METHODS
  Number of children with RH who met a set of low-risk criteria: no intracranial hemorrhage with or without a simple, nonoccipital skull fracture, normal mental status, and no bruising on the head or face.
  
  
  RESULTS
  Of the 194 patients without intracranial injury who underwent dilated eye examination, 141 children (72.7%) met low-risk criteria. None of these 141 patients had RH. Of the 53 participants who did not meet low-risk criteria, 2 children (3.8%) had RH.
  
  
  CONCLUSIONS
  In children evaluated for physical abuse who fulfill a set of low-risk criteria, the dilated eye examination should not be a necessary component of the abuse evaluation. Use of these criteria can significantly decrease the number of children who need to undergo a dilated eye examination as part of an evaluation for abusive head trauma.
authors.affiliation: Department of Pediatrics, Child Advocacy Center, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
authors.forename: Simiao
authors.initials: S
authors.lastname: Li
authors.forename: Ellen
authors.initials: E
authors.lastname: Mitchell
authors.forename: Janet
authors.initials: J
authors.lastname: Fromkin
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Berger
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000209:etiology; D003941:Diagnostic Techniques, Ophthalmological; D004106:Dilatation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012306:Risk; D012887:Skull Fractures / Q000209:etiology*