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Use of digital camera imaging of eye fundus for telemedicine in children suspected of abusive head injury
  1. M Saleh1,
  2. S Schoenlaub2,
  3. P Desprez2,
  4. T Bourcier1,
  5. D Gaucher1,
  6. D Astruc2,
  7. C Speeg-Schatz1
  1. 1
    Department of Ophthalmology, University Hospital of Strasbourg, France
  2. 2
    Department of Pediatrics, Intensive Care Unit, University Hospital of Strasbourg, France
  1. Dr M Saleh, Service d’ophtalmologie, 1 place de l’hôpital, 67000, Strasbourg, France; maher.saleh{at}


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.

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  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by the Ethical Committee in Pediatrics of Hautepierre Center.

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