title: Photographic assessment of retinal hemorrhages in infant head injury: the Childhood Hemorrhagic Retinopathy Study.
abstract: Retinal hemorrhages (RH) in babies in the absence of severe trauma or a medical cause have been strongly associated with abusive head trauma (AHT). We examined the pattern of RH in accidental head injury and AHT objectively using widefield retinal imaging.
  
  
  
  A total of 118 infants and children 1-36 months of age admitted with head injuries at two centers were included in this prospective, consecutive, comparative cohort study. Dilated fundus examination was performed with indirect ophthalmoscopy and widefield imaging. Designation of AHT was made using predetermined criteria independent of retinal findings. Retinal images were graded by two independent observers.
  
  
  
  There were 21 cases of AHT. RH were present in 14 cases (66%); macular retinoschisis or retinal folds, in 8 (38%). There were 86 cases of accidental head injuries, with RH present in 2 (2%); there were none with retinal folds or retinoschisis. In cases of head injury with intracranial hemorrhage, the positive likelihood ratio of AHT with RH was 5.7 (95% CI, 2.6-12.00) and negative likelihood ratio was 0.26 (95% CI, 0.11-0.62). A severe, panretinal pattern with multilayered hemorrhages was the most specific for AHT.
  
  
  
  Our imaging study confirmed that RH in infants with head injury have a high positive likelihood ratio for AHT. A severe hemorrhagic retinopathy, particularly in association with perimacular folds or macular retinoschisis, has the highest positive predictive value for AHT.
authors.affiliation: Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia. Electronic address: gauravb23@gmail.com.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Bhardwaj
authors.affiliation: Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia; Department of Ophthalmology, Prince of Wales and Sydney Children's Hospital, Randwick, NSW, Australia.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Jacobs
authors.affiliation: Department of Ophthalmology, Prince of Wales and Sydney Children's Hospital, Randwick, NSW, Australia; Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, NSW, Australia; Faculty of Medicine, University of Sydney, NSW, Australia.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Martin
authors.affiliation: Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia; Child Protection Unit, Sydney Children's Hospital, Randwick, NSW, Australia.
authors.forename: Kieran T
authors.initials: KT
authors.lastname: Moran
authors.affiliation: Department of Radiology, The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: Kristina
authors.initials: K
authors.lastname: Prelog
authors.affiliation: Department of Ophthalmology, Prince of Wales and Sydney Children's Hospital, Randwick, NSW, Australia; Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Donaldson
authors.affiliation: School of Psychiatry, Faculty of Medicine, University of New South Wales (UNSW), Randwick, NSW, Australia.
authors.forename: Ute
authors.initials: U
authors.lastname: Vollmer-Conna
authors.affiliation: Faculty of Medicine, University of New South Wales (UNSW), Sydney NSW, Australia; Department of Ophthalmology, Prince of Wales and Sydney Children's Hospital, Randwick, NSW, Australia.
authors.forename: Minas T
authors.initials: MT
authors.lastname: Coroneo
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009887:Ophthalmoscopy; D010781:Photography / Q000379:methods*; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D041441:Retinoschisis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed