Mgf. Gilliland et al., SYSTEMIC AND OCULAR FINDINGS IN 169 PROSPECTIVELY STUDIED CHILD DEATHS - RETINAL HEMORRHAGES USUALLY MEAN CHILD-ABUSE, Forensic science international, 68(2), 1994, pp. 117-132
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.