A Systematic Review of the Diagnostic Accuracy of Ocular Signs in Pediatric Abusive Head Trauma
A Systematic Review of the Diagnostic Accuracy of Ocular Signs in Pediatric Abusive Head Trauma
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DOI：
10.1016/j.ophtha.2009.09.040
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发表时间：
2010-05-01
期刊：
影响因子：
13.7
通讯作者：
Coroneo, Minas T.
中科院分区：
文献类型：
--
作者：
Bhardwaj, Gaurav;Chowdhury, Vivek;Coroneo, Minas T.
题目：目的系统评价各种眼部体征对儿童虐待性头部外伤（AHT）诊断的准确性，临床意义：眼内出血（IOH）、黄斑周围视网膜皱褶、外伤性视网膜劈裂和视神经鞘破裂是AHT的主要体征。支持这种解释的准确性的证据基础，但是，还没有进行系统的review.Methods：MEDLINE，EMBASE和循证医学评论进行了系统的关键字搜索的原始研究报告在AHT眼部的结果。文章进行了分级使用检查表的诊断准确性的系统评价。结果：初步搜索产生了971篇文章，其中55个相关的研究进行了分级，20项研究符合纳入标准，并被列入审查。IOH诊断AHT的敏感性为75%，特异性为94%。后极部视网膜内出血是最常见的发现，尽管广泛的、双侧的和多层的IOH是AHT最特异的。视神经鞘膜扩张术对AHT的敏感性和特异性分别为72%和71%。创伤性视网膜劈裂和黄斑周围视网膜褶皱分别为8%和14%的AHT，但没有报道在其他conditions.Conclusions：前瞻性的，连续的研究证实，IOH在婴儿，特别是双边，广泛的，和多层是高度特异性的AHT。在尸检研究中，视神经鞘损伤在AHT中比在其他条件下更常见。外伤性视网膜劈裂和黄斑周围皱褶在少数AHT中存在，但在其他情况下很少见到。
Topic: To review systematically the diagnostic accuracy of various ocular signs for pediatric abusive head trauma (AHT).Clinical Relevance: Intraocular hemorrhages (IOH), perimacular retinal folds, traumatic retinoschisis and optic nerve sheath hemorrhages have been reported as cardinal signs of AHT. The evidence base supporting the accuracy of this interpretation, however, has not been systematically reviewed.Methods: A systematic keyword search of MEDLINE, EMBASE, and Evidence-Based Medicine Reviews was conducted for original studies reporting ocular findings in AHT. Articles were graded using a checklist for systematic reviews of diagnostic accuracy.Results: The initial search yielded 971 articles, of which 55 relevant studies were graded, and 20 studies met inclusion criteria and were included in the review. The overall sensitivity of IOH for AHT was 75% and their specificity was 94%. Intraretinal hemorrhage at the posterior pole was the most common finding, although extensive, bilateral, and multilayered IOH were the most specific for AHT. Optic nerve sheath hemorrhages had a sensitivity and specificity for AHT of 72% and 71%, respectively. Traumatic retinoschisis and perimacular retinal folds were reported in 8% and 14% of AHT, respectively, but were not reported in other conditions.Conclusions: Prospective, consecutive studies confirm that IOH in infants-particularly bilateral, extensive, and multilayered-are highly specific for AHT. Optic nerve sheath hemorrhages are significantly more common in AHT than in other conditions, in autopsy studies. Traumatic retinoschisis and perimacular folds are present in a minority of AHT, but rarely seen in other conditions.