Ophthalmic ultrasonography can identify retinal injury associated with abusive head trauma more quickly and accurately than other neuroimaging modalities.

BACKGROUND AND

OBJECTIVES

We propose that ophthalmic ultrasonography (OUS) can identify retinal pathology faster and more accurately than head computed tomography (CT) or brain magnetic resonance imaging (MRI) when compared with dilated fundus exam.

METHODS

Children <4 years old admitted to the pediatric intensive care unit with suspected traumatic brain injury (TBI) confirmed by neuroimaging were enrolled in this multi-institution prospective observational cohort. All patients underwent bedside OUS exams and either a dilated fundus exam, an autopsy, or both. Head CT and brain MRI images were obtained per institutional TBI protocols.

RESULTS

Fifty patients, 37 males and 13 females, with an average age of 4 months (IQ: 2-14) were enrolled. Thirty-eight head CTs and 39 brain MRIs were obtained. On dilated fundoscopy 24 enrollees had bilateral retinal hemorrhages, 2 had unilateral retinal hemorrhages, and 24 had no retinal pathology. OUSs were obtained within 3 h of hospital arrival (SD ± 2), head CTs within 3.2 (±4.2) hours, brain MRIs within 56 (±75) hours, and fundus exams within 65 (±56) hours. Compared to fundus exam, head CT had a sensitivity of 35 % (CI: 15-61) and specificity of 100 % (CI: 81-100) for identifying retinal pathology. T2 weighted MRI had a sensitivity of 44 % (CI: 22-69) and a specificity of 100 % (CI: 37-77). MRI susceptibility weighted imaging had a sensitivity of 62 % (CI: 36-84) and specificity of 85 %(CI: 61-96). OUS had a sensitivity of 96 % (CI: 80-99.8) and a specificity of 100 % (CI: 84-100).

CONCLUSIONS

OUS was more accurate than other neuroimaging modalities at detecting retinal pathology and can be obtained faster than dilated fundus exams.