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Use of digital camera imaging of eye fundus for telemedicine in children suspected of abusive head injury
  1. Maher Saleh (mahers_fr{at}yahoo.fr),
  2. Salomé Schoenlaub,
  3. Philippe Desprez,
  4. tristan Bourcier,
  5. David Gaucher,
  6. Dominique Astruc,
  7. Claude Speeg-Schatz
  1. Department of Ophthalmology, University Hospital of Strasbourg, France
  2. Department of Pediatrics, Intensive Care Unit, University Hospital of Strasbourg, France
  3. Department of Pediatrics, Intensive Care Unit, University Hospital of Strasbourg, France
  4. Department of Ophthalmology, University Hospital of Strasbourg, France
  5. Department of Ophthalmology, University Hospital of Strasbourg, France
  6. Department of Pediatrics, Intensive Care Unit, University Hospital of Strasbourg, France
  7. Department of Ophthalmology, University Hospital of Strasbourg, France

    Abstract

    Purpose: 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.

    Participant: 21 children admitted in the pediatric units of the University Hospital of Strasbourg (France) with suspicion of abusive head trauma were included.

    Methods: Children were examined by standard ophthalmoscopy. Photographies were taken using the RetCam-120 Digital Retinal Camera (Clarity Medical Systems, Inc., CA, USA). Eye fundus images were stored and remotely read by an ophthalmologist. Patients also had radiographic skeletal series to look for bone fractures, and Computerized Tomography Scan and/or Magnetic Resonance Imaging (MRI) of the head to look for intracranial haemorrhages.

    Main outcome measures: The absence or presence of retinal hemorrhages was assessed by both methods. Feasability, sensitivity and specificity of the digital camera procedure were determined.

    Result: 85.7% of the children presented cerebral bleeding, and 14 out of the 21 children(66.7%)had retinal haemorrhages on ophthalmoscopy. Digital camera detected the retinal abnormalities in all cases. One false positive case was also reported. 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.

    Conclusion: Digital photography compared to ophthalmoscopy has 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.

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