Use of digital camera imaging of eye fundus for telemedicine in children suspected of abusive head injury.

AIM

Pilot study of the role of RetCam imaging for telemedicine in lieu of availability of ophthalmologist examination for cases of suspected abusive head injury.

DESIGN

Cross-sectional observational study.

PARTICIPANTS

21 children admitted in the paediatric units of the University Hospital of Strasbourg (France) with suspicion of abusive head trauma were included.

METHODS

Children were examined by standard ophthalmoscopy. Photographs were taken using the RetCam-120 Digital Retinal Camera. Eye fundus images were stored and remotely read by an ophthalmologist. Patients also had radiographic skeletal series to look for bone fractures, and CT scan and/or MRI of the head to look for intracranial haemorrhages.

MAIN OUTCOME MEASURES

The absence or presence of retinal haemorrhages was assessed by both methods. Feasability, sensitivity and specificity of the digital camera procedure were determined.

RESULTS

85.7% of the children presented cerebral bleeding, and 14 out of the 21 (66.7%) had retinal haemorrhages on ophthalmoscopy. The digital camera detected the retinal abnormalities in all cases. One false-positive case was also reported. The sensitivity of the digital camera detection method was 100% with a specificity of 85.7%. 14 patients were eventually diagnosed as suffering from abusive trauma. RetCam helped establishing the diagnosis of abuse in 92.8% of these cases.

CONCLUSIONS

Digital photography compared with ophthalmoscopy has a good sensitivity and specificity in detecting retinal haemorrhages. Remote reading of RetCam-120 photographs could be a promising strategy in detecting children with abusive head trauma.