Ocular Injuries in Pediatric Patients Admitted With Abusive Head Trauma

Pediatr Neurol. 2022 Feb:127:11-18. doi: 10.1016/j.pediatrneurol.2021.11.004. Epub 2021 Nov 13.


Background: Pediatric abusive head trauma (AHT) refers to head injury from intentional blunt force or violent shaking in children aged five years or less. We sought to evaluate the epidemiology of ocular injuries in AHT.

Methods: This retrospective analysis of the National Trauma Data Bank (2008 to 2014) identified children aged five years or less with AHT and ocular injuries using ICD-9-CM codes. Demographic data, types of ocular and nonocular/head injuries, geographic location, length of hospital admission, injury severity, and Glasgow Coma scores were tabulated and analyzed.

Results: A total of 10,545 children were admitted with AHT, and 2550 (24.2%) had associated ocular injuries; 58.7% were female. The mean age was 0.5 (±1.0) years. Most (85.7%) were aged one year or less. Common ocular injuries included contusion of eye/adnexa (73.7%) and retinal edema (59.3%), and common head injuries were subdural hemorrhage (SDH) (72.8%) and subarachnoid hemorrhage (22.9%). Retinal hemorrhages occurred in 5.3%. About 42.8% of children had injury severity scores greater than 24 (very severe), and the mortality rate was 19.2%. Children aged one year or less had the greatest odds of retinal hemorrhages (odds ratio [OR] = 2.44; P = 0.008) and SDH (OR = 1.55; P < 0.001), and the two- to three-year-old group had the greatest odds of contusions (OR = 1.68; P = 0.001), intracerebral hemorrhages (OR = 1.55; P = 0.002), and mortality (OR = 1.78; P < 0.001). For all ages, SDH occurred most frequently with retinal edema compared with other ocular injuries (OR = 2.25; P < 0.001).

Conclusions and relevance: Ocular injuries varied with age and were variably associated with nonocular injury. The youngest group was most frequently affected; however, the two- to three-year-old group was most likely to succumb to injuries.

Keywords: Ocular injuries; Pediatric abusive head trauma; Retinal edema; Retinal hemorrhages; Shaken baby syndrome; Subdural hemorrhages.

MeSH terms

  • Child Abuse / statistics & numerical data*
  • Child, Preschool
  • Edema / epidemiology
  • Edema / etiology
  • Eye Injuries* / epidemiology
  • Eye Injuries* / etiology
  • Female
  • Head Injuries, Closed* / complications
  • Head Injuries, Closed* / epidemiology
  • Hematoma, Subdural* / epidemiology
  • Hematoma, Subdural* / etiology
  • Humans
  • Infant
  • Male
  • Retinal Diseases* / epidemiology
  • Retinal Diseases* / etiology
  • Retinal Hemorrhage / epidemiology
  • Retinal Hemorrhage / etiology
  • Retrospective Studies
  • Severity of Illness Index
  • Shaken Baby Syndrome* / complications
  • Shaken Baby Syndrome* / epidemiology