Child Abuse: When Do We Get It Wrong?
Gil Binenbaum; Alex V. Levin; Steve E. Rubin; Cindy W. Christian
Children’s Hospital of Philadelphia
Purpose/Relevance: Abusive injuries must be considered as the potential cause of an anterior segment injury or posterior segment finding such as retinal detachment or retinal hemorrhage (RH) in childhood. This workshop aims to raise awareness of situations that may result in under or over diagnosis of abuse, either of which can result in adverse effects for children and families.
Target Audience: Ophthalmologists who regularly examine children of any age, but particularly children presenting with signs of ocular or adnexal trauma, young children being evaluated for potential abusive head trauma, or children less than two years of age regardless of the indication.
Current Practice: In the United States and Canada, all physicians are mandated reporters of suspected child abuse. As many as 10% of child abuse cases present with eye trauma, such as hyphema, open globe injury, or eyelid laceration. In addition, pediatric ophthalmologists frequently are called upon to interpret the pattern of RH observed in children with suspected abusive head trauma. Numerous alternative potential causes of such anterior and posterior segment findings may cause ophthalmologists to under or over diagnosis abuse.
Best Practice: Ophthalmologists play an important role in protecting both victimized children and innocent caregivers by accurately assessing the risk of an abusive injury, considering the consistency of the provided medical history with the observed ocular and adnexal findings. To meet this role, the pediatric ophthalmologist should remain vigilant for external signs of abuse, well versed in the diagnostic interpretation of specific RH patterns, and cognizant of systemic conditions that might mimic abuse.
Expected Outcomes: Participants will improve their ability to identify and distinguish among signs of abuse and mimickers of abuse and accurately communicate the level of suspicion to pediatricians and if necessary to legal officials in court.
Format: Case presentations with audience discussion led by child abuse pediatricians and ophthalmologists with expertise in the subject matter. The cases will highlight potential mistakes in the diagnosis of traumatic and non-traumatic conditions as well pitfalls in the clear communication of the likelihood of abuse to non-ophthalmologists.
Summary: Pediatric ophthalmologists may fail to identify subtle signs of child abuse, misdiagnose mimickers of abuse or not recognize the significance of particular patterns of ocular or retinal findings. This workshop will better equip audience members to make the correct diagnosis, whether it is trauma or not.
References: 1. Kohara EM, Levin AV: Ocular manifestations of child abuse. American Academy of Ophthalmology Focal Points: Clinical Modules for Ophthalmologists, 2016;34(1):18.
2. Christian CW, States LJ. Medical Mimics of Child Abuse. Am J Roentgenology 2017; 208:982-990.
3. Binenbaum G, Christian CW, Guttmann K, Huang J, Ying GS, Forbes B. Evaluation of Temporal Association Between Vaccinations and Retinal Hemorrhage in Children. JAMA Ophthalmol. 133(11):1261-5. 2015.