Casar Berazaluce Alejandra M, Moody Suzanne, Jenkins Todd, Farooqui Zishaan, Shebesta Kaaren, Kotagal Meeta, Falcone Richard A
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
J Pediatr Surg. 2021 May;56(5):1009-1012. doi: 10.1016/j.jpedsurg.2020.07.031. Epub 2020 Aug 5.
BACKGROUND/PURPOSE: Accurate identification of child physical abuse is crucial during the evaluation of injured children. Retinal hemorrhages (RH) are used for diagnosis, but clear criteria for screening with direct fundoscopic exam are lacking. We sought to identify key factors associated with RH to guide evaluations.
Electronic medical records for patients <1 year of age presenting to a Level I Pediatric Trauma Center with unwitnessed head injury from January 2015 to December 2018 were retrospectively reviewed. Multivariable logistic regression was used to identify factors associated with RH.
Two hundred and seventy-six patients were included; 63% underwent direct fundoscopic examination, of which 23% were positive and 77% were negative for RH. Unscreened patients tended to be older and have isolated skull fractures. Multivariable regression analysis revealed that abnormal GCS and subdural hemorrhage were positively associated with a diagnosis of retinal hemorrhage, while isolated skull fracture was negatively associated.
Children under 1 year of age with subdural hemorrhage have a greater risk of associated RH and should undergo routine screening with direct fundoscopic examination. Conversely, those with isolated skull fractures may not require an ophthalmology consultation. Standardized screening protocols may help reduce the risk of missing child physical abuse.
III (Diagnostic Test).
背景/目的：在评估受伤儿童时，准确识别儿童身体虐待至关重要。视网膜出血（RH）用于诊断，但缺乏直接检眼镜检查的明确筛查标准。我们试图确定与视网膜出血相关的关键因素以指导评估。
回顾性分析2015年1月至2018年12月在一级儿科创伤中心就诊的1岁以下无目击头部受伤患者的电子病历。采用多变量逻辑回归分析确定与视网膜出血相关的因素。
共纳入276例患者；63%接受了直接检眼镜检查，其中23%视网膜出血阳性，77%阴性。未接受筛查的患者往往年龄较大且有孤立性颅骨骨折。多变量回归分析显示，格拉斯哥昏迷评分（GCS）异常和硬膜下出血与视网膜出血诊断呈正相关，而孤立性颅骨骨折与之呈负相关。
1岁以下硬膜下出血患儿发生视网膜出血的风险更高，应接受直接检眼镜检查进行常规筛查。相反，那些有孤立性颅骨骨折的患儿可能不需要眼科会诊。标准化筛查方案可能有助于降低漏诊儿童身体虐待的风险。
III（诊断性试验）
