Ocular findings and long-term outcomes in pediatric abusive head trauma.

BACKGROUND

Pediatric abusive head trauma, colloquially known as shaken baby syndrome, is the most common cause of death and disability from child abuse. The purpose of this study was to characterize ocular and systemic findings in abusive head trauma and identify predictors of long-term visual and developmental outcomes.

METHODS

We conducted a retrospective cohort study of patients diagnosed with abusive head trauma at Children's Medical Center Dallas between 2006 and 2022. Inclusion criteria were ophthalmology consultation, positive eye findings, and high concern for abuse. Data was analyzed by logistic regression and the Fisher exact test, with significance at P < 0.05.

RESULTS

A total of 38 patients (24 males [63%]) were included. Mean age was 5.85 months (range, 1-20). All patients had subdural hematomas, and 74% required intubation. Of 73 injured eyes, 69 (95%) had intraretinal hemorrhage; 51 (70%), preretinal hemorrhage; 16 (22%), vitreous hemorrhage; and 11 (15%) subretinal hemorrhage. Three patients (8%) had unilateral findings. Disk pallor was a strong independent predictor of moderate to severe patient-level visual impairment (P < 0.001). Skull and long bone fractures were also associated with worse vision. Vitrectomy was performed in 15 eyes. Vitrectomy was not associated with improved visual outcomes compared to observation. 4 patients (11%) died during follow-up, and all had severe bilateral visual impairment.

CONCLUSIONS

Disk pallor, skull fractures, and long bone fractures were associated with poor visual outcomes in patients with abusive head trauma. Vitrectomy was not associated with improved visual outcomes, potentially because of confounding variables.