title: Prevalence of Retinal Hemorrhages in Infants Presenting with Isolated Long Bone Fractures and Evaluation for Abuse.
abstract: BACKGROUND
  Fractures are a frequent reason for emergency department visits and evaluation for abusive head trauma is an associated concern in infants. Recent guidelines have suggested that retinal examination may not be necessary in the absence of intracranial injury, but there is a lack of empirical evidence in infants < 1 year of age.
  
  
  OBJECTIVE
  Our aim was to evaluate the prevalence of retinal hemorrhages in infants with isolated long bone fractures.
  
  
  METHODS
  Retrospective chart review of infants < 1 year of age who presented to an urban, tertiary care pediatric hospital between January 2004 and April 2014 with the diagnosis of an acute long bone fracture or retinal hemorrhages. Patients were excluded for head injury, altered mental status, injury mechanism of motor vehicle accident, multiple fractures or injuries outside the fracture area. Patients were identified through trauma registry data and International Classification of Diseases codes.
  
  
  RESULTS
  One hundred and forty-six patients had isolated long bone fractures, of which 68 patients did not undergo a retinal examination and 78 patients had dilated eye examinations, with no patients identified as having retinal hemorrhages. There were 46 patients identified with retinal hemorrhages concerning for abuse. No patients with retinal hemorrhages had isolated long bone fractures.
  
  
  CONCLUSIONS
  In infants < 1 year of age presenting with isolated long bone fractures, a dilated eye examination to evaluate for retinal hemorrhages is not likely to yield additional information. Our results support recent studies that a subset of children and infants may not require dilated eye examinations in the evaluation of possible abuse.
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, St. Louis, Missouri.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Payne
authors.affiliation: Department of Pediatrics, Division of Child Protection, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, St. Louis, Missouri.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kutz
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, St. Louis, Missouri.
authors.forename: Ann
authors.initials: A
authors.lastname: Di Maio
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, St. Louis, Missouri.
authors.forename: James M
authors.initials: JM
authors.lastname: Gerard
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D004106:Dilatation; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology; D005360:Fibula / Q000293:injuries; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology; D007223:Infant; D008297:Male; D009887:Ophthalmoscopy; D015995:Prevalence; D011885:Radius Fractures / Q000453:epidemiology; D012166:Retinal Hemorrhage / Q000453:epidemiology*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000453:epidemiology; D014458:Ulna Fractures / Q000453:epidemiology
keywords: child; child abuse; fracture; infant; retinal hemorrhages