Curcoy Ana Isabel, Trenchs Victoria, Morales Marta, Serra Alicia, Pou Jordi
Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona, Spain.
Pediatr Emerg Care. 2010 Feb;26(2):118-20. doi: 10.1097/PEC.0b013e3181cfdb6b.
To determine the prevalence of retinal hemorrhages in apparent life-threatening events (ALTEs) with the purpose of facilitating the differential diagnosis of the cases of nonaccidental head trauma.
Prospective study on children aged 15 days to 2 years admitted to our hospital with a diagnosis of an ALTE over a period of 2 years (May 2004-May 2006). All the children underwent detailed ophthalmologic examination within 72 hours of admission. If retinal hemorrhages were detected, further investigation was undertaken to rule out systemic disorder or maltreatment.
One hundred eight children with an ALTE were examined. No patient was found to have retinal hemorrhages nor was any found to have experienced child abuse. Therefore, using the Hanley rule of 3, we can be confident to an upper limit of 95% that the chance of retinal hemorrhages occurring as a result of an ALTE alone is at the most 0.028.
Apparent life-threatening events alone are unlikely to cause retinal hemorrhages in children younger than 2 years. Therefore, if retinal hemorrhages are detected, investigation into the possibility of nonaccidental injury is essential.
确定在看似危及生命事件（ALTEs）中视网膜出血的患病率，以促进非意外性头部创伤病例的鉴别诊断。
对我院在2年期间（2004年5月至2006年5月）收治的诊断为ALTE的15天至2岁儿童进行前瞻性研究。所有儿童在入院72小时内接受了详细的眼科检查。如果检测到视网膜出血，则进行进一步调查以排除全身性疾病或虐待情况。
对108例ALTE患儿进行了检查。未发现有患儿出现视网膜出血，也未发现有任何遭受虐待的情况。因此，根据汉利3法则，我们可以有95%的上限把握确定，仅因ALTE导致视网膜出血的几率最高为0.028。
仅看似危及生命的事件不太可能在2岁以下儿童中引起视网膜出血。因此，如果检测到视网膜出血，调查非意外伤害的可能性至关重要。
