Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
Ophthalmology. 2010 May;117(5):983-992.e17. doi: 10.1016/j.ophtha.2009.09.040. Epub 2010 Mar 27.
To review systematically the diagnostic accuracy of various ocular signs for pediatric abusive head trauma (AHT).
Intraocular hemorrhages (IOH), perimacular retinal folds, traumatic retinoschisis and optic nerve sheath hemorrhages have been reported as cardinal signs of AHT. The evidence base supporting the accuracy of this interpretation, however, has not been systematically reviewed.
A systematic keyword search of MEDLINE, EMBASE, and Evidence-Based Medicine Reviews was conducted for original studies reporting ocular findings in AHT. Articles were graded using a checklist for systematic reviews of diagnostic accuracy.
The initial search yielded 971 articles, of which 55 relevant studies were graded, and 20 studies met inclusion criteria and were included in the review. The overall sensitivity of IOH for AHT was 75% and their specificity was 94%. Intraretinal hemorrhage at the posterior pole was the most common finding, although extensive, bilateral, and multilayered IOH were the most specific for AHT. Optic nerve sheath hemorrhages had a sensitivity and specificity for AHT of 72% and 71%, respectively. Traumatic retinoschisis and perimacular retinal folds were reported in 8% and 14% of AHT, respectively, but were not reported in other conditions.
Prospective, consecutive studies confirm that IOH in infants-particularly bilateral, extensive, and multilayered-are highly specific for AHT. Optic nerve sheath hemorrhages are significantly more common in AHT than in other conditions, in autopsy studies. Traumatic retinoschisis and perimacular folds are present in a minority of AHT, but rarely seen in other conditions.
系统综述儿科虐待性头部外伤（AHT）各种眼部征象的诊断准确性。
眼内出血（IOH）、黄斑区视网膜皱褶、外伤性视网膜劈裂和视神经鞘出血已被报道为 AHT 的主要征象。然而，支持这种解释准确性的证据基础尚未得到系统审查。
对 MEDLINE、EMBASE 和循证医学评价进行了系统的关键词搜索，以查找报告 AHT 眼部发现的原始研究。使用诊断准确性系统评价检查表对文章进行评分。
最初的搜索产生了 971 篇文章，其中 55 篇相关研究被评分，20 篇研究符合纳入标准并包含在综述中。IOH 对 AHT 的总体敏感性为 75%，特异性为 94%。后极部视网膜内出血是最常见的发现，尽管广泛、双侧和多层 IOH 对 AHT 最具特异性。视神经鞘出血对 AHT 的敏感性和特异性分别为 72%和 71%。外伤性视网膜劈裂和黄斑区视网膜皱褶分别在 8%和 14%的 AHT 中报告，但在其他情况下未报告。
前瞻性、连续研究证实，婴儿的 IOH——尤其是双侧、广泛和多层 IOH——对 AHT 具有高度特异性。在尸检研究中，视神经鞘出血在 AHT 中比在其他情况下更为常见。外伤性视网膜劈裂和黄斑区皱褶在少数 AHT 中存在，但在其他情况下很少见。
