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Br J Ophthalmol. 2009 Apr;93(4):424-8. doi: 10.1136/bjo.2008.147561. Epub 2008 Nov 19.

Use of digital camera imaging of eye fundus for telemedicine in children suspected of abusive head injury.

Author information

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

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.

PMID:
19019943
DOI:
10.1136/bjo.2008.147561
[Indexed for MEDLINE]
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