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

Becky J Riggs; Misun Hwang; Joanna S Cohen; Katherine Barton; Matthew A Thimm; Megan F Hunt; Carmelina Trimboli-Heidler; Thomas J Valvano; Courtney L Kraus; Nathan P Dean; Aylin Tekes

doi:10.1016/j.chiabu.2025.107474

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

Child Abuse Negl. 2025 Jul:165:107474. doi: 10.1016/j.chiabu.2025.107474. Epub 2025 Apr 29.

Authors

Affiliations

¹ Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System, Washington, DC, USA; Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Doernbecher Children's Hospital at Oregon Health & Sciences University, Portland, OR, USA. Electronic address: riggsbe@ohsu.edu.
² Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA; Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³ Division of Emergency Medicine, Children's National Health System, Washington, DC, USA; Department of Pediatrics, Division of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, OR, USA.
⁵ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Division of Ophthalmology, Children's National Health System, Washington, DC, USA; Division of Ocular Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada.
⁷ Department of Pediatrics, Division of General Pediatrics, Doernbecher Children's Hospital at Oregon Health & Science University, Portland, OR, USA.
⁸ Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
⁹ Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System, Washington, DC, USA; Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
¹⁰ Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology and Section of Pediatric Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA.

PMID: 40306202
DOI: 10.1016/j.chiabu.2025.107474

Abstract

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.

Publication types

Observational Study
Multicenter Study

MeSH terms

Brain Injuries, Traumatic* / diagnostic imaging
Child Abuse* / diagnosis
Child, Preschool
Craniocerebral Trauma* / complications
Craniocerebral Trauma* / diagnostic imaging
Female
Humans
Infant
Magnetic Resonance Imaging
Male
Neuroimaging / methods
Prospective Studies
Retina* / diagnostic imaging
Retina* / injuries
Retinal Hemorrhage / diagnostic imaging
Sensitivity and Specificity
Tomography, X-Ray Computed
Ultrasonography