Citation

Saleh M, Schoenlaub S, Desprez P, Bourcier T, Gaucher D, Astruc D, Speeg-Schatz C. Br. J. Ophthalmol. 2009; 93(4): 424-428.

Affiliation

Service d'ophtalmologie, 1 place de l'hôpital, 67000, Strasbourg, France. maher.saleh@chru-strasbourg.fr

Copyright

(Copyright © 2009, BMJ Publishing Group)

DOI

10.1136/bjo.2008.147561

PMID

19019943

Abstract

AIM: Pilot study of the role of RetCam imaging for telemedicine in lieu of availability of ophthalmologist examination for cases of suspected abusive head injury. DESIGN: Cross-sectional observational study. PARTICIPANTS: 21 children admitted in the paediatric units of the University Hospital of Strasbourg (France) with suspicion of abusive head trauma were included. METHODS: Children were examined by standard ophthalmoscopy. Photographs were taken using the RetCam-120 Digital Retinal Camera. Eye fundus images were stored and remotely read by an ophthalmologist. Patients also had radiographic skeletal series to look for bone fractures, and CT scan and/or MRI of the head to look for intracranial haemorrhages. MAIN OUTCOME MEASURES: The absence or presence of retinal haemorrhages was assessed by both methods. Feasability, sensitivity and specificity of the digital camera procedure were determined. RESULTS: 85.7% of the children presented cerebral bleeding, and 14 out of the 21 (66.7%) had retinal haemorrhages on ophthalmoscopy. The digital camera detected the retinal abnormalities in all cases. One false-positive case was also reported. The sensitivity of the digital camera detection method was 100% with a specificity of 85.7%. 14 patients were eventually diagnosed as suffering from abusive trauma. RetCam helped establishing the diagnosis of abuse in 92.8% of these cases. CONCLUSIONS: Digital photography compared with ophthalmoscopy has a good sensitivity and specificity in detecting retinal haemorrhages. Remote reading of RetCam-120 photographs could be a promising strategy in detecting children with abusive head trauma.

Language: en