Koti Ajay S, Brown Emily C B, Campbell Kristine A
Pediatr Emerg Care. 2025 Feb 1;41(2):127-130. doi: 10.1097/PEC.0000000000003293. Epub 2024 Oct 30.
Subconjunctival hemorrhages (SCHs) are uncommon injuries in young children beyond the neonatal period and have been associated with abuse. In otherwise well infants, they are sometimes attributed to commonly observed symptoms that invoke Valsalva maneuvers, such as cough, vomiting, and constipation. Our study aims to ascertain the prevalence of SCH among children presenting to emergency care with cough, vomiting, and constipation.
We conducted a cross-sectional secondary analysis of a prospectively collected dataset of children aged 1 month to 3 years presenting to a tertiary pediatric emergency department (ED). Children with and without SCH were identified at the time of their examination by ED providers. Children were assigned to Valsalva symptom groups of cough, vomiting, and/or constipation based on review of the ICD-10 codes associated with the ED encounter. Descriptive statistics and prevalence were calculated for each group. Chi-square testing of proportions was used to compare the prevalence of SCH based on the presence or absence of the 3 symptoms of interest.
Four thousand seven hundred seventeen qualifying ED encounters were captured, with 2 total cases of SCH identified (0.4 per 1000). SCHs were uncommonly observed in patients with cough (0.5 per 1000), vomiting (0 per 1000), and constipation (0 per 1000). We found no significant differences in the prevalence of SCH based on the presence or absence of cough ( P = 0.87), vomiting ( P = 0.52), or constipation ( P = 0.82).
SCH is an uncommon finding in children under 3 years and is similarly uncommon among children with cough, vomiting, or constipation. It should not be attributed to uncomplicated presentations of cough, vomiting, or constipation, and alternative diagnoses, including abuse, should be carefully considered in the differential diagnosis of SCH.
结膜下出血（SCHs）在新生儿期后的幼儿中是不常见的损伤，且与虐待有关。在其他方面健康的婴儿中，它们有时被归因于引发瓦尔萨尔瓦动作的常见症状，如咳嗽、呕吐和便秘。我们的研究旨在确定因咳嗽、呕吐和便秘前往急诊就诊的儿童中SCH的患病率。
我们对前瞻性收集的1个月至3岁儿童前往三级儿科急诊科（ED）就诊的数据集进行了横断面二次分析。急诊医护人员在检查时识别出有和没有SCH的儿童。根据与急诊就诊相关的ICD-10编码回顾，将儿童分为咳嗽、呕吐和/或便秘的瓦尔萨尔瓦症状组。计算每组的描述性统计数据和患病率。使用比例的卡方检验来比较基于三种感兴趣症状的有无的SCH患病率。
共记录了4717次符合条件的急诊就诊，共识别出2例SCH病例（每1000例中有0.4例）。咳嗽患者（每1000例中有0.5例）、呕吐患者（每1000例中有0例）和便秘患者（每1000例中有0例）中很少观察到SCH。我们发现基于咳嗽（P = 0.87）、呕吐（P = 0.52）或便秘（P = 0.82）的有无，SCH患病率没有显著差异。
SCH在3岁以下儿童中是不常见的发现，在咳嗽、呕吐或便秘的儿童中同样不常见。它不应归因于咳嗽、呕吐或便秘的单纯表现，在SCH的鉴别诊断中应仔细考虑包括虐待在内的其他诊断。
