Accidental head trauma and retinal hemorrhage.

Retinal hemorrhage and intracranial hemorrhage in a child with little external evidence of trauma and with a poorly documented history are considered pathognomonic child abuse. The mechanism and magnitude of force required to produce the injuries are seldom witnessed or known. This study was designed to determine the incidence of retinal hemorrhage in pediatric head injuries under known accidental circumstances, in association with forces sufficient to cause skull fracture and/or intracranial hemorrhage. Of 525 consecutive hospital admissions for head injuries, 200 children filled these criteria. Thirty children were excluded because of suspected child abuse or gunshot wounds. Of the remaining 170, 140 were evaluated by an ophthalmologist for retinal hemorrhage. Two children, who were both involved in side-impact car accidents, had retinal hemorrhages in associated with severe head injury. Retinal hemorrhage occurs rarely in accidental head injury and is associated with extraordinary force.