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Quality standards for ophthalmological examination

Ranking used 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?


  • The optimal standard was studies in which all children had been examined by an ophthalmologist, using indirect ophthalmoscopy and pupillary dilatation (+/- additional retinal imaging) with detailed recording of the retinal findings relating to retinal haemorrhage (laterality, layers of retina involved, number and extent – from optic disc to peripheral retina – of haemorrhages) and additional features (e.g. retinoschisis)
  • However, this detailed description was not always available and the minimum accepted standard was examination undertaken by an ophthalmologist since it is well recognised that non-ophthalmologists may miss retinal haemorrhages and additional findings are unlikely to have been documented in detail

3. Ranking used for retinal haemorrhages in newborn infants



Quality standards for retinal examination


Examined by ophthalmologist, dilated pupil examination AND indirect ophthalmoscopy clearly documented


Examined by ophthalmologist, with use of ‘RetCam’ (making the assumption that the baby’s pupils were dilated)


Examined by ophthalmologist, EITHER dilated pupil examination documented without mention of examination method, OR indirect ophthalmoscopy documented without mention of pupil status


Examined by ophthalmologist, no details regarding pupil dilatation or use of indirect ophthalmoscopy, and only if detailed documentation of retinal hemorrhages is included


Mixed Ranking


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