Researchers say criterion for diagnosing child abuse not always accurate

buse, Lantz decided to look for the condition during autopsies to learn more about when they occur.

Previously, the only way to look for the hemorrhages during an autopsy was to remove the eyes. Lantz came up with an alternative performing eye exams during autopsies using a surgical headlight and a handheld lens. This simple technique is sometimes used by ophthalmologists when more sophisticated equipment is not available, but no one had ever reported using it during autopsies.

The 700 deaths were in people ranging in age from birth to 96. Causes of death or conditions associated with retinal hemorrhages included suffocation, sudden infant death syndrome, meningitis, blunt trauma to the head, ruptured cerebral aneurysms, hemorrhagic strokes, cancer that had spread to the brain, high blood pressure, bleeding disorders, diabetes and gunshot wounds to the head.

"Many doctors have been taught to look for the hemorrhages when they suspect child abuse and often will diagnose child abuse without considering other possibilities," Lantz said. "Our research shows that you see the hemorrhages in a variety of different situations in infants, children and adults."

According to medical literature, retinal hemorrhages in infants are rare except in cases of abuse. "We're finding just the opposite," said Lantz. "We've found more retinal hemorrhages in non-abuse cases than in abuse cases, but most doctors don't look in the eyes of children unless they suspect child abuse."

Retinal hemorrhages were found in 30 children under age 14, yet only 6 cases were associated with child abuse.

As one of the first pathologists to routinely look at the back of the eye during autopsies, Lantz has learned that the technique can help diagnose hypertension, glaucoma, Marfan syndrome and even diabetes. He has taught residents and medical students to conduct the examinations and published an article in the Journal of Forensic Science (Nov. 2005) on th

Contact: Karen Richardson
Wake Forest University Baptist Medical Center

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