6104 Ophthalmology examination in potential non accidental injury: an audit of patient selection and assessment

Objectives Retinal haemorrhages are found in 70–80% of cases of abusive head trauma (AHT)¹ and the examination of retinae is an important part of the investigation of AHT. It is often used in a wider context in younger children, especially non mobile infants, with injuries. The Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Ophthalmology (RCO) have produced guidelines on performing such assessments.¹ ² Methods We looked at 2 years of medical examinations undertaken by a district general hospital under section 47 (S47) of the Children's act 1989. We audited which children met either local or RCPCH guidelines for Ophthalmology assessment, if they had that assessment, and whether that assessment had been carried out in accordance with RCPCH and RCO guidance. Results From August 2021 to July 2023 222 S47 medicals were performed. 162 were for patients over 2 years of age and none of those were assessed for occult retinal injury by ophthalmologists. 23 were between 1 and 2 years of age, six of them had potentially inflicted injuries. One, who had a head injury, was assessed by ophthalmology. 37 were under 1 year; 6 of them had head injuries, 2 of which were witnessed or explained with no concern, the other 4 all had ophthalmology examinations. Of the 31 who had no signs of head injury or AHT 17 had further investigations and those 17 all had ophthalmology assessment. There was only one positive finding of retinal haemorrhage which was likely to be perinatal. Audit of the 22 ophthalmology assessments showed that 13 (56%) were done the same or next day and all were done within three working days. None were performed by consultants and the documentation, including the use of the proforma, was variable. This will be improved by creating a new pathway for ophthalmology examinations linked to S47 examination. Conclusion This audit highlights that, although the sensitivity of ophthalmology examinations is high in AHT, it is rarely positive when used as a screening test in other cases of potential non accidental injury. By following the narrative of the RCPCH companion that describes it as a screening test in children with other signs of AHT¹ we may improve sensitivity and specificity when compared to the RCPCH companion recommendation to perform such assessments on all children under 2 years of age when physical abuse is suspected¹. References https://childprotection.rcpch.ac.uk/child-protection-companion-content/ accessed 6/10/23. Abusive head trauma and the eye in infancy; RCPCH and RCO 2013.