{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:46:16Z","timestamp":1788453976956,"version":"build-2803163510"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>To assess the frequency and yield of retinal examination in children below 2 years old undergoing abuse evaluations in the setting of skull fracture(s) and small underlying intracranial hemorrhage.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>This cross-sectional study used CAPNET, a multicenter child physical abuse network, to identify children below 2 years with a skull fracture(s) and intracranial injury limited to an underlying small focal intracranial hemorrhage undergoing subspeciality child abuse evaluations. Our outcomes of interest were (1) the performance of a retinal examination, (2) the identification of retinal hemorrhages, and (3) associations of clinical factors and CAPNET site with the performance of retinal examinations. We hypothesized that retinal hemorrhages would be identified in &lt;5% of patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Of 242 children who met inclusion criteria, the majority (189, 78.1%) presented with a reported history of accidental trauma, and most (211, 87.2%) lacked additional injuries. Only 9 (3.7%) had loss of consciousness and\/or seizures\/seizure-like activity. The majority (201, 83.1%) had low concern for abuse. Overall, 104 (43.0%) children underwent retinal examinations, of which 0 had retinal hemorrhages (one-sided 95% CI: 0-2.8%). Children without a reported accidental mechanism of injury (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.004), those with intermediate\/high concern for abuse (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt;0.001), and children with occipital fractures (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.008) were more likely than their counterparts to undergo retinal examination. The proportion of children undergoing retinal examination varied by CAPNET site (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt;0.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Our findings suggest that it may be reasonable to forgo retinal examinations in children below 2 years of age with skull fracture(s) and intracranial injury limited to an underlying small focal hemorrhage who are overall neurologically well-appearing.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003334","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T11:00:34Z","timestamp":1741777234000},"page":"407-414","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Ophthalmology Examinations in Children With Skull Fractures and Underlying Focal Hemorrhage"],"prefix":"10.1097","volume":"41","author":[{"given":"Karli","family":"Breeden","sequence":"first","affiliation":[{"name":"Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy W.","family":"Christian","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne N.","family":"Wood","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Clinical Futures, and PolicyLab, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Binenbaum","sequence":"additional","affiliation":[{"name":"Division of Ophthalmology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Lindberg","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Bachim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Public Health Pediatrics, Baylor College of Medicine, Texas Children\u2019s Hospital, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen J.","family":"Bressler","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, Division of Child Abuse Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Frasier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\u202f, Penn State Children's Hospital,\u202f Penn State Hershey College of Medicine, Penn State Hershey Medical Center, Center for the Protection of Children, Hershey, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terra","family":"Frazier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Child Adversity and Resilience, University of Missouri Kansas City, Medical School, Children\u2019s Mercy Hospital and Clinics, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole R.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Center for Safe and Healthy Children, University of Minnesota Medical School, Minneapolis, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Laub","sequence":"additional","affiliation":[{"name":"Rady Children's Hospital, University of California San Diego, San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan M.","family":"Letson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The Ohio State University College of Medicine, The Center for Family Safety & Healing, Nationwide Children\u2019s Hospital, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tagrid","family":"Ruiz-Maldonado","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Center for Safe & Healthy Families, Primary Children\u2019s Hospital, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Valente","sequence":"additional","affiliation":[{"name":"UPMC Children's Hospital of Pittsburgh, Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Kiely","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, PolicyLab Children\u2019s Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children\u2019s Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Katherine","family":"Henry","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of General Pediatrics, Clinical Futures, Children\u2019s Hospital of Philadelphia"},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Roberts Center for Pediatric Research, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"R1-20250530","doi-asserted-by":"crossref","first-page":"e20200203","DOI":"10.1542\/peds.2020-0203","article-title":"Abusive head trauma in infants and children","volume":"145","author":"Narang","year":"2020","journal-title":"Pediatrics"},{"key":"R2-20250530","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.jpedsurg.2020.07.031","article-title":"Catching the red eye: a retrospective review of factors associated with retinal hemorrhage in child physical abuse","volume":"56","author":"Casar Berazaluce","year":"2021","journal-title":"J Pediatr Surg"},{"key":"R3-20250530","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/aos.14936","article-title":"Predictive value of non-ocular findings for retinal haemorrhage in children evaluated for non-accidental trauma","volume":"100","author":"Giannakakos","year":"2022","journal-title":"Acta Ophthalmol"},{"key":"R4-20250530","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jaapos.2015.12.008","article-title":"The natural history of retinal hemorrhage in pediatric head trauma","volume":"20","author":"Binenbaum","year":"2016","journal-title":"J AAPOS"},{"key":"R5-20250530","doi-asserted-by":"crossref","first-page":"e20181411","DOI":"10.1542\/peds.2018-1411","article-title":"The eye examination in the evaluation of child abuse","volume":"142","author":"Christian","year":"2018","journal-title":"Pediatrics"},{"key":"R6-20250530","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1067\/mpd.2003.161","article-title":"Nonophthalmologist accuracy in diagnosing retinal hemorrhages in the shaken baby syndrome","volume":"142","author":"Morad","year":"2003","journal-title":"J Pediatrics"},{"key":"R7-20250530","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1001\/archpediatrics.2011.150","article-title":"Retinal hemorrhages in low-risk children evaluated for physical abuse","volume":"165","author":"Li","year":"2011","journal-title":"Arch Pediatr Adolesc Med"},{"key":"R8-20250530","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/acem.12972","article-title":"Potentially avoidable pediatric interfacility transfer is a costly burden for rural families: a cohort study","volume":"23","author":"Mohr","year":"2016","journal-title":"Acad Emerg Med"},{"key":"R9-20250530","doi-asserted-by":"crossref","first-page":"e750","DOI":"10.1097\/PEC.0000000000001777","article-title":"Profiling pediatric potentially avoidable transfers using procedure and diagnosis codes","volume":"37","author":"Rosenthal","year":"2021","journal-title":"Pediatr Emerg Care"},{"key":"R10-20250530","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jaapos.2014.12.007","article-title":"Risk factors associated with retinal hemorrhage in suspected abusive head trauma","volume":"19","author":"Burkhart","year":"2015","journal-title":"J AAPOS"},{"key":"R11-20250530","doi-asserted-by":"crossref","first-page":"e1066","DOI":"10.1542\/peds.2009-2184","article-title":"Yield of retinal examination in suspected physical abuse with normal neuroimaging","volume":"125","author":"Thackeray","year":"2010","journal-title":"Pediatrics"},{"key":"R12-20250530","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.jpeds.2013.01.063","article-title":"Dedicated retinal examination in children evaluated for physical abuse without radiographically identified traumatic brain injury","volume":"163","author":"Greiner","year":"2013","journal-title":"J Pediatr"},{"key":"R13-20250530","doi-asserted-by":"crossref","first-page":"106606","DOI":"10.1016\/j.chiabu.2023.106606","article-title":"Retinal hemorrhage variation in inertial versus contact head injuries","volume":"149","author":"Sokoloff","year":"2024","journal-title":"Child Abuse Neglect"},{"key":"R14-20250530","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.acap.2022.07.001","article-title":"Child abuse pediatrics research network: the CAPNET Core Data Project","volume":"23","author":"Wood","year":"2023","journal-title":"Acad Pediatr"},{"key":"R15-20250530","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1542\/peds.2007-0883","article-title":"American Academy of Pediatrics Committee on Child Abuse and Neglect. 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