Buys Y M, Levin A V, Enzenauer R W, Elder J E, Letourneau M A, Humphreys R P, Mian M, Morin J D
Department of Ophthalmology, Hospital for Sick Children, Toronto, Ontario, Canada.
Ophthalmology. 1992 Nov;99(11):1718-23. doi: 10.1016/s0161-6420(92)31741-5.
Many authorities believe that the finding of retinal hemorrhages in a child younger than 3 years of age with a history of head trauma, in the absence of an obvious cause for the injury, is pathognomonic of child abuse. To date, no studies have examined the prospective retinal examination of children who have had head trauma. The authors undertook such a study because the presence of retinal hemorrhage from any head trauma in children may have medicolegal diagnostic significance in differentiating accidental from nonaccidental trauma.
Seventy-nine children younger than 3 years of age, each of whom experienced head injury, underwent an ophthalmologic assessment, which included a dilated funduscopic examination.
Seventy-five children sustained accidental head injuries and had normal funduscopic examinations. Three children had nonaccidental head injuries and all were found to have varying degrees of retinal hemorrhages. One child, with a normal fundus examination, had injuries that were of indeterminate cause.
The finding of retinal hemorrhages in a child with a head injury suggests a nonaccidental cause.
许多权威人士认为，3岁以下儿童头部受伤后出现视网膜出血，且无明显受伤原因，这是虐待儿童的特征性表现。迄今为止，尚无研究对头部受伤儿童进行前瞻性视网膜检查。作者开展此项研究是因为儿童头部外伤导致的视网膜出血在区分意外创伤和非意外创伤方面可能具有法医学诊断意义。
79名3岁以下头部受伤的儿童接受了眼科评估，包括散瞳眼底检查。
75名儿童遭受意外头部损伤，眼底检查正常。3名儿童遭受非意外头部损伤，均发现有不同程度的视网膜出血。1名眼底检查正常的儿童，其损伤原因不明。
头部受伤儿童出现视网膜出血提示为非意外原因。
