title: Quantitative measurement of retinal hemorrhages in suspected victims of child abuse.
abstract: OBJECTIVE
  Child abuse is one of the leading causes of death in early childhood. The presence of retinal hemorrhages often supports the diagnosis. The purpose of this study was to determine whether the specific measurement of retinal hemorrhages when present on fundus photography correlates with other clinical findings typically seen in children suspected of having been abused.
  
  
  METHODS
  The medical records of children with retinal hemorrhages who were suspected of being victims of abusive head trauma from June 2003 to June 2013 and who had widefield retinal photography performed were retrospectively reviewed. Data collected included hemorrhage-covered percentage (HCP) of the central retina (posterior pole or 40° circle centered on fovea) measured by ImageJ in relation to death, length of hospital stay, presence of abnormal findings on neuroimaging or skeletal survey, and definite versus possible abuse.
  
  
  RESULTS
  Significant difference in retinal hemorrhage measured on fundus photography was found in patients with axial skeletal fracture (P = 0.016), signs of severe brain trauma on neuroimaging (P = 0.014) and definite versus possible abuse (P = 0.023). No correlation of quantitative measurement of the retinal hemorrhage to length of hospital stay, death, or the presence of skull fracture was found in this cohort.
  
  
  CONCLUSIONS
  The quantitative measurement of total retinal hemorrhage when present on fundus photography centered on posterior pole in children suspected of having been abused correlated with some but not all findings typically seen in abused children.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa; Department of Pediatrics, University of Iowa. Electronic address: Susannah-longmuir@uiowa.edu.
authors.forename: Susannah Q
authors.initials: SQ
authors.lastname: Longmuir
authors.affiliation: Department of Pediatrics, University of Iowa.
authors.forename: Resmiye
authors.initials: R
authors.lastname: Oral
authors.affiliation: Department of Pediatrics, University of Iowa.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Walz
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa.
authors.forename: Pavlina S
authors.initials: PS
authors.lastname: Kemp
authors.affiliation: Department of Pediatrics, University of Iowa.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ryba
authors.affiliation: Department of Biostatistics, University of Iowa.
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Zimmerman
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Abramoff
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D016489:Head Injuries, Closed / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010781:Photography / Q000379:methods; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D038642:Shaken Baby Syndrome / Q000175:diagnosis