TOP 64 - Clinical Characteristics of Subconjunctival Hemorrhages and Physical Abuse Evaluations

Publication Number: 4768.TOP 64

Kelly N. McGregory, University of Minnesota Medical School, Minneapolis, MN, United States; Caroline L.S.. George, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Loralie Peterson, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States

Background: The association of subconjunctival hemorrhages (SCH) and child physical abuse is well described in the TEN-4-FACESp Bruising Clinical Bruising Decision Rule for children under four years of age. Subconjunctival hemorrhages can be caused by abusive trauma, medical conditions and accidental trauma. One case series described three infants with isolated, bilateral subconjunctival hemorrhages associated with physical abuse and recommended consideration of abuse in isolated, unexplained large bilateral SCH in infants even if there are no other physical exam findings to suggest abuse. A case-control study of fifty infants and toddlers with subconjunctival hemorrhages found that 25% of the children had isolated subconjunctival hemorrhages and occult injuries were discovered at the same rate as children with signs of injury in addition to the subconjunctival hemorrhage. Another study found inadequate screening of children with subconjunctival hemorrhages. When screening was conducted, occult injuries were frequently discovered, thus supporting the need for occult injury screening. Occult injury screening in young infants includes radiation exposure and blood testing which can cause distress to parents.

Objective: The objective of this study is to determine the presenting symptoms and clinical characteristics of isolated subconjunctival hemorrhages in young infants and children evaluated by a child abuse team and to determine the yield of physical abuse evaluations in this population.

Design/Methods: We conducted a retrospective cross-sectional study with data collection from chart review of a Midwest United States health system-based child abuse team. Patients less than 4 years ( < 48 months) referred to a child abuse pediatrics team for child abuse evaluation with an apparently isolated SCH were included in the study. Demographic data was collected including age, sex, race, ethnicity, and insurance status. Clinical data was collected including history of presentation to care, signs and symptoms, physical exam findings including the clinical characteristics of subconjunctival hemorrhages on photodocumentation review, lab and imaging results if obtained and child abuse provider level of concern for abuse. Analysis will include frequency data, associations of the clinical appearance of subconjunctival hemorrhages and results of diagnostic studies.