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Retinal Findings

 The objective was to answer the following three questions:

 

  1. What differences are found between abusive head trauma retinal findings versus non-abusive head trauma retinal findings? 
  2. What are the differential diagnoses of retinal haemorrhages in children with clinical features associated with child abuse?

  3. Retinal haemorrhages in newborn infants:

    a) What are the retinal findings in newborn infants?
    b) What are the obstetric correlates to retinal haemorrhages in the newborn?
    c) What is the evolution of newborn retinal haemorrhages?

  4. Which features or characteristics of eye injury are present in child maltreatment, neglect and fabricated or induced illness?

We aimed to:

  • Identify discriminating features relating to the retinal haemorrhage findings in abusive head trauma and other traumatic and non-traumatic conditions in childhood
  • Determine the prevalence of retinal haemorrhages in conditions proposed as confounders  amongst abusive head trauma (AHT) cases i.e. seizure, cough, apparent life-threatening events (ALTE), cardiopulmonary resuscitation (CPR)
  • Characterise the retinal findings in newborn infants to assist those assessing babies aged less than three months of age who may present with suspected head trauma and retinal abnormalities

Methodology for:

1. What differences are found between abusive head trauma retinal findings versus non-abusive head trauma retinal findings?

2. What are the differential diagnoses of retinal haemorrhages in children with clinical features associated with child abuse?

 

We performed an all-language literature search of original articles, their references and conference abstracts published since 1950.  The initial search strategy was developed across OVID Medline databases using keywords and Medical Subject Headings (MeSH headings) and was modified appropriately to search the remaining bibliographic databases.  The search sensitivity was augmented by the use of a range of supplementary ‘snowballing’ techniques including consultation with subject experts and relevant organisations, and hand searching selected websites, non-indexed journals and the references of all full-text articles.

 

Standardised data extraction and critical appraisal forms were based on criteria defined by the National Health Service’s Centre for Reviews and Dissemination1.  We also used a selection of systematic review advisory articles to develop our critical appraisal forms 2-6. Articles were independently reviewed by two reviewers.  A third review was undertaken to resolve disagreement between the initial reviewers when determining either the evidence type of the article or whether the study met the inclusion criteria.  Decisions related to inclusion and exclusion criteria were guided by Cardiff Child Protection Systematic Reviews, who laid out the basic parameters for selecting the studies.

 

Our panel of reviewers included paediatricians, ophthalmologists, pathologists, neonatologists and designated and named doctors in child protection. All reviewers underwent standardised critical appraisal training, based on the CRD critical appraisal standards 3, and this was supported by a dedicated electronic critical appraisal module.

 

Methodology for:

3. Retinal haemorrhages in newborn infants:

a) What are the retinal findings in newborn infants?

b) What are the obstetric correlates to retinal haemorrhages in the newborn?

c) What is the evolution of newborn retinal haemorrhages?

 

 

We performed an all-language literature search of original articles, their references and conference abstracts published since 1970.  The initial search strategy was developed across OVID Medline databases using keywords and Medical Subject Headings (MeSH headings) and was modified appropriately to search the remaining bibliographic databases.  The search sensitivity was augmented by the use of a range of supplementary ‘snowballing’ techniques including consultation with subject experts and relevant organisations, and hand searching selected websites, non-indexed journals and the references of all full-text articles.

 

Standardised data extraction and critical appraisal forms were based on criteria defined by the National Health Service’s Centre for Reviews and Dissemination1.  We also used a selection of systematic review advisory articles to develop our critical appraisal forms 2-6. Articles were independently reviewed by two reviewers.  A third review was undertaken to resolve disagreement between the initial reviewers when determining either the evidence type of the article or whether the study met the inclusion criteria.  Decisions related to inclusion and exclusion criteria were guided by Cardiff Child Protection Systematic Reviews, who laid out the basic parameters for selecting the studies.

 

Methodology for:

4. Which features or characteristics of eye injury are present in child maltreatment, neglect and fabricated or induced illness?

 

We performed an all-language literature search of original articles, their references and conference abstracts published since 1970.  The initial search strategy was developed across OVID Medline databases using keywords and Medical Subject Headings (MeSH headings) and was modified appropriately to search the remaining bibliographic databases.  The search sensitivity was augmented by the use of a range of supplementary ‘snowballing’ techniques including consultation with subject experts and relevant organisations, and hand searching selected websites, non-indexed journals and the references of all full-text articles.

 

Standardised data extraction and critical appraisal forms were based on criteria defined by the National Health Service’s Centre for Reviews and Dissemination1.  We also used a selection of systematic review advisory articles to develop our critical appraisal forms 2-6. Articles were independently reviewed by two reviewers.  A third review was undertaken to resolve disagreement between the initial reviewers when determining either the evidence type of the article or whether the study met the inclusion criteria.  Decisions related to inclusion and exclusion criteria were guided by Cardiff Child Protection Systematic Reviews, who laid out the basic parameters for selecting the studies.

 

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References

  1. Centre for Reviews and Dissemination. Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care, 2009 Centre for Reviews and Dissemination, University of York. [PDF from York University]
  2. Weaver N, Williams JL, Weightman AL, Kitcher HN, Temple JM, Jones P, Palmer S. Taking STOX: developing a cross disciplinary methodology for systematic reviews of research on the built environment and the health of the public. Journal of Epidemiology and Community Health. 2002;56(1):48-55. [Pubmed]
  3. Critical Appraisal Skills Programme (CASP) [Website]

  4. Polgar A, Thomas SA. Chapter 22. Critical evaluation of published research in Introduction to research in the health sciences. 3rd edition. Melbourne: Churchill Livingstone, 1995.
  5. Weightman AL, Mann MK, Sander L, Turley RL. Health Evidence Bulletins Wales: A systematic approach to identifying the evidence. Project Methodology 5. Cardiff: Information Services UWCM, January 2004. [PDF from Health Evidence Bulletins Wales]
  6. Rychetnik L, Frommer M. A schema for evaluating evidence on public health interventions (version 4). National Public Health Partnership, Melbourne 2002. [PDF from The National Public Health Partnership]

 

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