SYSTEMIC AND OCULAR FINDINGS IN 169 PROSPECTIVELY STUDIED CHILD DEATHS - RETINAL HEMORRHAGES USUALLY MEAN CHILD-ABUSE

The presence and location of ocular hemorrhages were prospectively stu died in 169 randomly selected child deaths referred to a medical exami ner. Causes of death in the study group included natural diseases and various injuries involving the head, trunk, and asphyxia. Retinal hemo rrhages were identified in 70 cases: 62 head injuries, four central ne rvous system diseases (but not other natural diseases), and four death s of undetermined cause. The presence of retinal, peripheral retinal, optic nerve sheath, and intrascleral hemorrhages were strongly associa ted with head injury as compared to other injuries and natural disease s (Yates corrected P-values < 0.001). Among the head-injured with reti nal hemorrhages, nine had a history of severe traumatic event (e.g., a n unrestrained rear-seat passenger in high-speed collision) and 53 wer e victims of inflicted injury (e.g. violent shaking). In the absence o f a verifiable history of a severe head injury or life-threatening cen tral nervous system disease, retinal and ocular hemorrhages were diagn ostic of child abuse.