title: The natural history of retinal hemorrhage in pediatric head trauma.
abstract: BACKGROUND
  Ophthalmologists are commonly asked to interpret appearance of retinal hemorrhages (RH) in children with suspected traumatic head injury. We sought to determine the natural history of RH in young children with head trauma and to identify patterns suggestive of chronicity in order to help establish timing of suspected traumatic injury.
  
  
  METHODS
  The medical records of children <2 years of age with abusive or accidental head trauma and RH on initial fundus examination who had 1 or more follow-up examination were retrospectively reviewed. Types of RH (intraretinal, preretinal) were noted; intraretinal hemorrhage (IRH) severity was graded as mild (0-10), moderate (10-20), or severe (>20, too numerous to count [TNTC]).
  
  
  RESULTS
  A total of 91 eyes of 52 children were studied. All eyes had IRH (62 eyes with TNTC). In all but one eye, IRH resolved to none or mild within 1-2 weeks. TNTC IRH did not persist beyond a few days. The longest an isolated IRH persisted was 32 days. Preretinal hemorrhage (PRH) was present in 68 eyes, persisting 5-111 days. On initial examination, 25% of eyes had only IRH, 75% both PRH and IRH; no eyes had only PRH. At 2 weeks, 3% had only IRH, 18% both, and 45% only PRH. In no eyes did RH worsen.
  
  
  CONCLUSIONS
  IRH clears rapidly, whereas PRH may persist for many weeks. The presence of TNTC IRHs indicates that trauma occurred within a few days prior to examination, whereas the presence of PRH with no or few IRHs suggests days to weeks since trauma. To accurately identify these patterns, eye examinations should be completed as soon as possible after admission, preferably within 24-48 hours.
authors.affiliation: Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia; Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia. Electronic address: binenbaum@email.chop.edu.
authors.forename: Gil
authors.initials: G
authors.lastname: Binenbaum
authors.affiliation: Division of Ophthalmology, Alpert Medical School at Brown University, Providence, Rhode Island.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chen
authors.affiliation: Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Jiayan
authors.initials: J
authors.lastname: Huang
authors.affiliation: Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.affiliation: Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Forbes
mesh_terms: D000059:Accidents; D002649:Child Abuse / Q000175:diagnosis*; D006259:Craniocerebral Trauma / Q000145:classification / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012166:Retinal Hemorrhage / Q000145:classification / Q000175:diagnosis*; D012189:Retrospective Studies