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Prevalence of Retinal Haemorrhages in Critically Ill Children

Prevalence of Retinal Haemorrhages in Critically Ill Children. Journal Club Tuesday 26 th June 2012 Louise Ramsden. Aim. To determine the prevalence of retinal haemorrhage when excluding those caused by NAI. Objectives. Search for literature relevant to question Select a paper to discuss

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Prevalence of Retinal Haemorrhages in Critically Ill Children

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  1. Prevalence of Retinal Haemorrhages in Critically Ill Children Journal Club Tuesday 26th June 2012 Louise Ramsden

  2. Aim To determine the prevalence of retinal haemorrhage when excluding those caused by NAI

  3. Objectives Search for literature relevant to question Select a paper to discuss Determine the validity and reliability of the paper Assess whether this may alter local clinical practice

  4. Why have I selected this topic? Literature looking at RH in abusive head trauma Limited regarding general population Children with critical illness more likely to have the RFs that may be assoc with RH

  5. The Clinical Question In critically ill children without abusive head trauma what is the prevalence of retinal haemorrhage and what are the associated factors?

  6. Prevalence of Retinal Haemorrhages in Critically Ill Children Agrawal S., Peters M.J., Adams G.G.W., Pierce C.M. Pediatrics 2012; 129(6): e1388 – e1395

  7. Methods • All emergency PICU admissions • Excluded elective admissions,< 6 weeks of age, Direct ocular trauma, Known / suspected AHT • Note taken of admission diagnosis, haematological Ix, CPR episodes, seizures • Consent obtained • Dilated fundoscopic exam or retinal photography

  8. Less than 6 weeks old N=650 More than or equal to 6 weeks N=610 Excluded N=254 (Elective admissions 245, Direct ocular trauma 9) Met inclusion criteria N=356 Refused Consent N=195 Recruited N=161 Excluded N=2 Final Analyses N=159 Total number of PICU admissions N=1260

  9. Outcome measures • No universal grading system for retinal haemorrhage • Unilateral / bilateral • Mild (<5) • Moderate (5-20) • Severe (>20) • Single or multilayered • Primary; Prevalence and distribution of retinal haemorrhages in critically ill children • Secondary; Association with admission diagnosis and coagulopathy, age and gender

  10. Are the results of the study valid?

  11. What are the results? RH’s in 15.1% (95% CI 9.5-21%) - mild 10% - mod 1.2% - severe 3.8% No impact from age, gender, traumatic brain injury, non traumatic encephalopathy Sepsis (OR 3.2 P=0.018) and coagulopathy (OR 2.8 P=0.025) positively assosciated Respiratory failure (OR 0.23 P=0.018) negatively associated No RH seen in CPR without assoc sepsis or coagulopathy

  12. Will the results help me locally?

  13. Summary and Conclusion Prevalence of RH is 15% in critically ill children Association with coagulopathy and sepsis Severe RH rare with other causes Good study to identify prevalence Identifys some RFs but these need closer analysis

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