{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:35:39Z","timestamp":1793352939679,"version":"4.5.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Retinal hemorrhages (RHs) are reported as rare in children with concerns for physical abuse without intracranial injury (ICI). The current performance of retinal examinations in this population is unknown. We sought to assess factors associated with performing a retinal examination in young children without ICI and describe the yield of these examinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We performed a retrospective, multicenter cross-sectional study of children younger than 2 years undergoing subspecialty physical abuse evaluations between February 2021 and August 2023. Children were excluded if they had ICI, lacked neuroimaging, had RHs prompting evaluation for abuse, or died. Outcomes were (1) performance of a retinal examination and (2) yield of these examinations. We used descriptive statistics to report frequencies and proportions, and \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      or Fisher exact tests to assess unadjusted associations between clinical and consult characteristics with performance of retinal examinations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 2591 children without ICI, retinal examinations were obtained in 10.5% (272). Performance of a retinal examination was significantly associated with younger age, in-person CAP evaluation, transfer status, CAPNET site, presence of high-risk bruising, presence of high-risk fractures, presence of subconjunctival hemorrhage, evidence of head trauma, and ill appearance. Four (1.5%) of the 272 children receiving retinal examinations had RHs on examination, all of which had potential alternate explanations for the RHs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Retinal examinations rarely reveal RHs in young children without ICI who are undergoing abuse evaluations, suggesting that these examinations may be safely deferred in this population. Retinal examinations may be warranted in cases of suspected strangulation or other signs of ocular trauma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003655","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T12:00:11Z","timestamp":1783166411000},"page":"e194-e199","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Performance and Yield of Retinal Examinations in Cases of Suspected Physical Abuse Without Intracranial Injury"],"prefix":"10.1097","volume":"42","author":[{"given":"Irene","family":"Hamlin","sequence":"first","affiliation":[{"name":"Perelman School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karli","family":"Breeden-Carino","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"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, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne N.","family":"Wood","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Binenbaum","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine A.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Utah, Center for Safe and Healthy Families, Primary Children\u2019s Hospital, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Lindberg","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The Kempe Center for the Prevention and Treatment of Child Abuse and 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":"Lori","family":"Frasier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Penn State Children\u2019s Hospital, 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":"Caroline L.S.","family":"George","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Minnesota, Minneapolis, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Horton","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Child Adversity and Resilience, Children\u2019s Mercy Hospital, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Laub","sequence":"additional","affiliation":[{"name":"University of California San Diego, Rady Children\u2019s Hospital, 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 and Healing, Nationwide Children\u2019s Hospital, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Valente","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The Paul C. Gaffney Division of Pediatric Hospital Medicine, Division of Child Advocacy, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Kiely","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, PolicyLab, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Katherine","family":"Henry","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of General Pediatrics, Clinical Futures, and PolicyLab, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"issue":"suppl 4","key":"R1-20261030","doi-asserted-by":"crossref","first-page":"S571","DOI":"10.1007\/s00247-014-3107-9","article-title":"The eye in child abuse: key points on retinal hemorrhages and abusive head trauma","volume":"44","author":"Binenbaum","year":"2014","journal-title":"Pediatr Radiol"},{"key":"R2-20261030","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.1007\/s00381-022-05610-8","article-title":"The eye in child abuse","volume":"38","author":"Christian","year":"2022","journal-title":"Childs 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Emerg Care"},{"key":"R13-20261030","doi-asserted-by":"crossref","first-page":"e215832","DOI":"10.1001\/jamanetworkopen.2021.5832","article-title":"Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics","volume":"4","author":"Pierce","year":"2021","journal-title":"JAMA Netw Open"},{"key":"R14-20261030","doi-asserted-by":"crossref","first-page":"e945","DOI":"10.1542\/peds.2007-2485","article-title":"Variability in expert assessments of child physical abuse likelihood","volume":"121","author":"Lindberg","year":"2008","journal-title":"Pediatrics"},{"key":"R15-20261030","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jaapos.2012.07.012","article-title":"Newborn retinal hemorrhages: a systematic review","volume":"17","author":"Watts","year":"2013","journal-title":"J AAPOS"},{"key":"R16-20261030","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":"R17-20261030","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1038\/s41433-019-0523-y","article-title":"Birth-related subconjunctival and retinal haemorrhages in the Newborn Eye Screening Test (NEST) Cohort","volume":"33","author":"Ji","year":"2019","journal-title":"Eye"}],"container-title":["Pediatric Emergency 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