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Inclusion criteria

 See evidence sheets and critical appraisal forms section for each year’s update

 

Criteria used to answer ‘what differences are found between abusive head trauma retinal findings versus non-abusive head trauma retinal findings? ‘

 

Inclusion 

Exclusion 

Studies of children aged 0 to <11 years

Consensus statements or personal practice studies

Abusive head trauma (AHT) – ranking of abuse of 1-2

AHT – ranking of abuse within study of 3-5 or mixed ranking where cases ranked 1-2 could not be extracted

Non-abusive head trauma – non-abusive aetiology confirmed (abuse excluded / accident confirmed

 Study exclusively addresses retinal findings in association with:

  • prior ophthalmic surgery
  • solid mass lesions of the eye (e.g. retinoblastoma) or brain
  • post mortem examination alone (i.e. where eyes not examined in life)
  • medical causes of retinal haemorrhage (RH)
  • RH found in the immediate postnatal period

blunt trauma to the eye

Ophthalmic examination performed by an ophthalmologist

Ophthalmic examination performed by non-ophthalmologist

Comparative studies

Non-comparative studies

Ophthalmic findings described with reference to severity, location and laterality

 

 

Criteria used to answer ‘What are the differential diagnoses of retinal haemorrhages in children with clinical features associated with child abuse?’

Inclusion 

Exclusion 

Children <15 years old examined while alive

Adult data or mixed child and adult data where child data could not be extrapolated

Medical diagnosis confirmed

Organic disease stated but not explicitly confirmed by clinical test or by characteristic clinical profile

Ophthalmic examination performed by an ophthalmologist

Major trauma

 

Details of retinal haemorrhages (RH) found, to include at least one of: layer, location or severity recorded

Solid mass lesion of the eye, retinopathy of prematurity or diabetes mellitus, newborn RH

RH as the primary ophthalmological finding

Ophthalmic surgery prior to RH detection

Children with proposed confounding condition (seizures, acute life threatening event, cough, cardiopulmonary resuscitation, hypoxia, osteogenesis imperfecta, immunisations, Vitamin D deficiency) examined for presence of RH

Known coagulopathy or severe anaemia diagnosed prior to presentation with RH

Post-mortem studies

Vitreous haemorrhage precluding visualisation of the retina

RH as a consequence of birth

 

Criteria used to address ‘retinal haemorrhages in newborn infants’

Inclusion criteria

Exclusion criteria

Ophthalmic examination performed by an ophthalmologist within 120 hours (5 days) of birth, and prior to discharge from obstetric unit

Infants not examined prior to discharge from hospital

 

 

Ophthalmic examination with the pupils dilated using the indirect ophthalmoscope

Cases with confirmed or suspected child abuse

 

Ophthalmic examination conducted using a ‘RetCam’ where the images were reviewed by an ophthalmologist

Preterm infants born prior to 32 weeks gestation

Studies conducted within Organisation for Economic Co-operation and Development (OECD) countries to attain greatest consistency in obstetric practices

Birth weight of less than 1500g of any gestation

Infants who have undergone ophthalmic surgery

Post-mortem studies

Infants with congenital eye conditions and/or established organic eye disease including Retinopathy of Prematurity (ROP)

Studies in which the presence of vitreous hemorrhages obscures the fundal view

Studies in which the ophthalmologic examination has been carried out by anyone other than an ophthalmologist, regardless of their training

Infants who have sustained blunt trauma to the eye(s)

Animal studies

 

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