Abstract: Retinal hemorrhages in pediatric patients can be a diagnostic challenge for ophthalmolo-gists. These hemorrhages can occur due to various underlying etiologies, including abusive head trauma, accidental trauma, and medical conditions. Accurate identification of the etiology is crucial for appropriate management and legal considerations. In recent years, deep learning techniques have shown promise in assisting healthcare professionals in making more accurate and timely di-agnosis of a variety of disorders. We explore the potential of deep learning approaches for differ-entiating etiologies of pediatric retinal hemorrhages. Our study, which spanned multiple centers, analyzed 898 images, resulting in a final dataset of 597 retinal hemorrhage fundus photos are categorized into medical (49.9%) and trauma (50.1%) etiologies. Deep learning models, specifically those based on ResNet and transformer architectures were applied; FastViT-SA12, a hybrid transformer model, achieved the highest accuracy (90.55%) and area under the receiver operating characteristic curve (AUC) of 90.55%, while ResNet18 secured the highest sensitivity value (96.77%) on an independent test dataset. The study highlighted areas for optimization in artificial intelligence (AI) models specifically for pediatric retinal hemorrhages. While AI proves valuable in diagnosing these hemorrhages, the expertise of medical professionals remains irreplaceable. Collaborative efforts between AI specialists and pediatric ophthalmologists are crucial to fully harness AI's potential in diagnosing etiologies of pediatric retinal hemorrhages.

Donny W. Suh, M.D., FAAP, MBA, FACS, works at the University of California, Irvine (UCI), Gavin Herbert Eye Institute and at Children’s Hospital of Orange County (CHOC) He is a Professor and Chief of Pediatric Ophthalmology and Eye Mobile Program in the Department of Ophthalmology, UCI. He completed his pediatric ophthalmology and strabismus fellowship at The Wilmer Eye Institute, Johns Hopkins University School of Medicine and his ophthalmology residency at The Eye Institute, Medical College of Wisconsin. He received his medical doctorate from Baylor College of Medicine in Houston, Texas and he also received his Bachelor of Arts in biochemistry from Rice University. University in Houston, Texas.