NEW YORK (Reuters Health) – Children being checked for possible physical abuse do not need to have a dilated eye exam if they meet a set of clinical criteria indicating a low risk of retinal hemorrhage, according to a report in the October issue of the Archives of Pediatrics and Adolescent Medicine.

“We recognize that it is difficult for physicians to be comfortable eliminating certain evaluations because of concern that pathology could be missed,” the authors acknowledge. “The next step in the process of implementing these clinical criteria is to assess the impact of their use on clinical behavior by using well-accepted, evidence-based recommendations.”

Dr. Rachel P. Berger and colleagues with the University of Pittsburgh Medical Center, Pennsylvania, note that timely diagnosis of abusive head trauma is critical. Part of the diagnostic process is an eye exam looking for characteristic patterns of retinal hemorrhage, which is one of the clearest indicators of abuse.

However, the availability of an ophthalmologist familiar with pediatric issues can be problematic. Furthermore, a recent study suggested that a dilated eye exam may not be necessary in certain low-risk cases.

To look into this further, the team determined the prevalence of retinal hemorrhage in 194 infants and children evaluated for abuse who did not have intracranial injury on neuroimaging.

Within this group, 141 children met predefined criteria for low risk: i.e., no intracranial hemorrhage, no skull fracture or a simple nonoccipital fracture, normal mental status, and no bruising on the head or face. None of the children so classified had retinal hemorrhage. Among the 53 subjects who did not meet these low-risk criteria, 2 had retinal hemorrhage.

“In children evaluated for physical abuse who fulfill a set of low-risk criteria, the dilated eye examination should not be a necessary component of the abuse evaluation,” Dr. Berger and colleagues conclude. “Use of these criteria can significantly decrease the number of children who need to undergo a dilated eye examination as part of an evaluation for abusive head trauma.”

Arch Pediatr Adolesc Med 2011;165:913-917.