Retinal hemorrhage variation in inertial versus contact head injuries
Copyright © 2023 Elsevier Ltd. All rights reserved..
BACKGROUND: Abusive head trauma (AHT) is frequently accompanied by dense/extensive retinal hemorrhages to the periphery with or without retinoschisis (complex retinal hemorrhages, cRH). cRH are uncommon without AHT or major trauma.
OBJECTIVE: The study objectives were to determine whether cRH are associated with inertial vs. contact mechanisms and are primary vs. secondary injuries.
PARTICIPANTS AND SETTING: This retrospective study utilized a de-identified PediBIRN database of 701 children <3-years-old presenting to intensive care for head trauma. Children with motor vehicle related trauma and preexisting brain abnormalities were excluded. All had imaging showing head injury and a dedicated ophthalmology examination.
METHODS: Contact injuries included craniofacial soft tissue injuries, skull fractures and epidural hematoma. Inertial injuries included acute impairment or loss of consciousness and/or bilateral and/or interhemispheric subdural hemorrhage. Abuse was defined in two ways, by 1) predetermined criteria and 2) caretaking physicians/multidisciplinary team's diagnostic consensus.
RESULTS: PediBIRN subjects with cRH frequently experienced inertial injury (99.4 % (308/310, OR = 53.74 (16.91-170.77)) but infrequently isolated contact trauma (0.6 % (2/310), OR = 0.02 (0.0004-0.06)). Inertial injuries predominated over contact trauma among children with cRH sorted AHT by predetermined criteria (99.1 % (237/239), OR = 20.20 (6.09-67.01) vs 0.5 % (2/339), OR = 0.04 (0.01-0.17)). Fifty-nine percent of patients with cRH, <24 h altered consciousness, and inertial injuries lacked imaging evidence of brain hypoxia, ischemia, or swelling.
CONCLUSIONS: cRH are significantly associated with inertial angular acceleration forces. They can occur without brain hypoxia, ischemia or swelling suggesting they are not secondary injuries.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:149 |
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| Enthalten in: |
Child abuse & neglect - 149(2024) vom: 27. März, Seite 106606 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sokoloff, Michael [VerfasserIn] |
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| Links: |
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| Themen: |
Abusive head trauma |
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| Anmerkungen: |
Date Completed 12.03.2024 Date Revised 27.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.chiabu.2023.106606 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366253867 |
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| 100 | 1 | |a Sokoloff, Michael |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Retinal hemorrhage variation in inertial versus contact head injuries |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 12.03.2024 | ||
| 500 | |a Date Revised 27.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Abusive head trauma (AHT) is frequently accompanied by dense/extensive retinal hemorrhages to the periphery with or without retinoschisis (complex retinal hemorrhages, cRH). cRH are uncommon without AHT or major trauma | ||
| 520 | |a OBJECTIVE: The study objectives were to determine whether cRH are associated with inertial vs. contact mechanisms and are primary vs. secondary injuries | ||
| 520 | |a PARTICIPANTS AND SETTING: This retrospective study utilized a de-identified PediBIRN database of 701 children <3-years-old presenting to intensive care for head trauma. Children with motor vehicle related trauma and preexisting brain abnormalities were excluded. All had imaging showing head injury and a dedicated ophthalmology examination | ||
| 520 | |a METHODS: Contact injuries included craniofacial soft tissue injuries, skull fractures and epidural hematoma. Inertial injuries included acute impairment or loss of consciousness and/or bilateral and/or interhemispheric subdural hemorrhage. Abuse was defined in two ways, by 1) predetermined criteria and 2) caretaking physicians/multidisciplinary team's diagnostic consensus | ||
| 520 | |a RESULTS: PediBIRN subjects with cRH frequently experienced inertial injury (99.4 % (308/310, OR = 53.74 (16.91-170.77)) but infrequently isolated contact trauma (0.6 % (2/310), OR = 0.02 (0.0004-0.06)). Inertial injuries predominated over contact trauma among children with cRH sorted AHT by predetermined criteria (99.1 % (237/239), OR = 20.20 (6.09-67.01) vs 0.5 % (2/339), OR = 0.04 (0.01-0.17)). Fifty-nine percent of patients with cRH, <24 h altered consciousness, and inertial injuries lacked imaging evidence of brain hypoxia, ischemia, or swelling | ||
| 520 | |a CONCLUSIONS: cRH are significantly associated with inertial angular acceleration forces. They can occur without brain hypoxia, ischemia or swelling suggesting they are not secondary injuries | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Intramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Abusive head trauma | |
| 650 | 4 | |a Child physical abuse | |
| 650 | 4 | |a Retinal hemorrhages | |
| 650 | 4 | |a Retinoschisis | |
| 650 | 4 | |a Traumatic brain injury | |
| 700 | 1 | |a Feldman, Kenneth W |e verfasserin |4 aut | |
| 700 | 1 | |a Levin, Alex V |e verfasserin |4 aut | |
| 700 | 1 | |a Rockter, Adam |e verfasserin |4 aut | |
| 700 | 1 | |a Armijo-Garcia, Veronica |e verfasserin |4 aut | |
| 700 | 1 | |a Musick, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a Weeks, Kerri |e verfasserin |4 aut | |
| 700 | 1 | |a Haney, Suzanne B |e verfasserin |4 aut | |
| 700 | 1 | |a Marinello, Mark |e verfasserin |4 aut | |
| 700 | 1 | |a Herman, Bruce E |e verfasserin |4 aut | |
| 700 | 1 | |a Frazier, Terra N |e verfasserin |4 aut | |
| 700 | 1 | |a Carroll, Christopher L |e verfasserin |4 aut | |
| 700 | 1 | |a Hymel, Kent P |e verfasserin |4 aut | |
| 700 | 0 | |a Pediatric Brain Injury Research Network (PediBIRN) Investigators |e verfasserin |4 aut | |
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