Abusive Head Trauma
- Bruises to the head and face have been associated with AHT, and patterns of injury consistent with grabbing, choking and blunt trauma should be sought.
- Clinicians should perform a meticulous examination for external bruises, soft tissue swelling and tenderness.
- The absence of external trauma to the head and neck is common and sometimes soft-tissue injuries including scalp hematomas are only evident at autopsy.
- Skull, rib and long bone fractures have been noted in AHT. Palpate the scalp, long bones and thorax for fractures.
- Ocular findings in AHT include orbital and lid ecchymosis, subconjunctival hemorrhage, anisocoria and disconjugate eye movements and retinal hemorrhages.
- Retinal hemorrhages are an important finding in AHT. When abuse is suspected, a prompt complete examination is indicated, including full indirect opthalmoscopic examination through dilated pupils (ophthalmologist).
Accessible Version
For the physical examination, one has to recognize that bruises to the head and face have been associated with AHT, and patterns of injury consistent with grabbing, choking and blunt trauma should be sought. This means that clinicians should perform a meticulous examination for external bruises, soft tissue swelling and tenderness and realize that the absence of external trauma to the head and neck is common and sometimes soft-tissue injuries including scalp hematomas are only evident at autopsy. Skull, rib and long bone fractures have been noted in AHT, s it is important to palpate the scalp, long bones and thorax for injuries. Ocular findings in AHT include orbital and lid ecchymosis, subconjunctival hemorrhage, anisocoria and disconjugate eye movements and retinal hemorrhages. Retinal hemorrhages are an important finding in AHT. It is therefore important to obtain a retinal exam and a prompt complete examination is indicated, including full indirect ophthalmoscopic examination through dilated pupils, usually done by an ophthalmologist.
