Retinal imaging holds clues to cause of brain injury in children

By Helen Albert, Senior medwireNews Reporter

Retinal imaging can help differentiate intentional from accidental traumatic brain injury (TBI) in children, suggests research.

Robert Minns (University of Edinburgh, UK) and colleagues found that a combination of young age and a high number of "dot-blot" intraretinal hemorrhages on imaging was highly predictive of intentional TBI.

Although such hemorrhages were also seen in children with accidental TBI, they tended to be more superficial, less frequent, and usually only observed in one layer of the retina, as opposed to all layers in children with intentional TBI.

Writing in Pediatrics, Minns and team report results from a 6-year prospective, observational study of 114 consecutive children, aged 47.8 months on average, who were admitted to hospital with traumatic and nontraumatic head injury. The children all had detailed retinal pictures taken within 24 hours of admission.

Multiagency child protection case conferences were used to confirm intentional TBI cases. Overall, 21 cases were confirmed as intentional TBI, 57 as accidental TBI, and 36 as having other nontraumatic etiology (NTE).

Retinal hemorrhages were significantly more common in children with intentional brain injury than those with other NTE or accidental TBI, at 85.7% versus 25.0% and 12.2%, respectively.

The researchers found that the positive predictive value for intentional over accidental TBI was 93% in children under the age of 3 years with more than 25 dot-blot or intraretinal hemorrhages. Negative predictive value for these children was 55%, sensitivity was 72%, and specificity was 86%.

Children with intentional TBI had hemorrhages in all retinal layers with a mean of 14, 28, and 31 hemorrhages in the peripapillary, macula, and peripheral zones, respectively, whereas those with accidental TBI had a mean 4.3, 4.0, and 1.5 retinal hemorrhages in the corresponding zones.

In general, those with accidental injury had more superficial, less widespread hemorrhages nearer to the optic disc.

"This high predictive value may support medico-legal deliberations," say Minns and co-investigators. They suggest that future developments in imaging technology may improve the value of retinal imaging for prediction of intentional TBI further still.

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