Retinal Hemorrhages and Shaken Baby Syndrome

An Evidence-Based Review

Brandon Togioka, Meghan A. Arnold, Melinda A. Bathurst, Susan M. Ziegfeld, Rosemary Nabaweesi, Paul M. Colombani, David C. Chang, Fizan Abdullah

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background: Among the causes of non-accidental head injury (NAHI), shaken baby syndrome (SBS) is difficult to diagnose and is associated with retinal hemorrhages (RH). Description: To identify findings and patterns of RH specific to SBS, a PubMed search using the keywords "shaken baby syndrome" or "child abuse" and "retinal hemorrhage" was conducted; 66 articles met the inclusion criteria. The published data address the utility of RH in three categories: 1) in diagnosing SBS; 2) as correlated to intracranial pathology; and 3) in prognosticating SBS. The present review aimed to summarize studies in a way that facilitates clinical decision-making. Results: Studies found a 53-80% incidence of RH with abusive head injury and a 0-10% incidence with proven severe accidental trauma. RHs are found bilaterally 62.5-100% of the time in SBS cases, and flame-shaped hemorrhages are the most common. The incidence of RH from convulsions, chest compressions, forceful vomiting, and severe persistent coughing in the absence of another condition known to cause RH is 0.7%, 0-2.3%, 0%, and 0%, respectively. Conclusion: SBS remains a difficult cause of NAHI to diagnose. Ophthalmologic examination can provide critical diagnostic and prognostic information in cases of suspected SBS. Child abuse should be highly suspect in children with RH and a parental explanation of accidental head injury, especially if the RHs are found to be bilateral, flame-shaped, or to extend through to all layers of the retina.

Original languageEnglish (US)
Pages (from-to)98-106
Number of pages9
JournalJournal of Emergency Medicine
Volume37
Issue number1
DOIs
StatePublished - Jul 2009
Externally publishedYes

Fingerprint

Shaken Baby Syndrome
Retinal Hemorrhage
Craniocerebral Trauma
Child Abuse
Incidence
PubMed
Vomiting
Retina
Seizures
Thorax
Pathology
Hemorrhage

Keywords

  • child abuse
  • pediatric
  • retinal hemorrhages
  • shaken baby syndrome

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Togioka, B., Arnold, M. A., Bathurst, M. A., Ziegfeld, S. M., Nabaweesi, R., Colombani, P. M., ... Abdullah, F. (2009). Retinal Hemorrhages and Shaken Baby Syndrome: An Evidence-Based Review. Journal of Emergency Medicine, 37(1), 98-106. https://doi.org/10.1016/j.jemermed.2008.06.022

Retinal Hemorrhages and Shaken Baby Syndrome : An Evidence-Based Review. / Togioka, Brandon; Arnold, Meghan A.; Bathurst, Melinda A.; Ziegfeld, Susan M.; Nabaweesi, Rosemary; Colombani, Paul M.; Chang, David C.; Abdullah, Fizan.

In: Journal of Emergency Medicine, Vol. 37, No. 1, 07.2009, p. 98-106.

Research output: Contribution to journalArticle

Togioka, B, Arnold, MA, Bathurst, MA, Ziegfeld, SM, Nabaweesi, R, Colombani, PM, Chang, DC & Abdullah, F 2009, 'Retinal Hemorrhages and Shaken Baby Syndrome: An Evidence-Based Review', Journal of Emergency Medicine, vol. 37, no. 1, pp. 98-106. https://doi.org/10.1016/j.jemermed.2008.06.022
Togioka, Brandon ; Arnold, Meghan A. ; Bathurst, Melinda A. ; Ziegfeld, Susan M. ; Nabaweesi, Rosemary ; Colombani, Paul M. ; Chang, David C. ; Abdullah, Fizan. / Retinal Hemorrhages and Shaken Baby Syndrome : An Evidence-Based Review. In: Journal of Emergency Medicine. 2009 ; Vol. 37, No. 1. pp. 98-106.
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