Characteristics of ocular trauma in the United StatesABSTRACT
Purpose: We aimed to study the characteristics of ocular trauma, an important but largely preventable global cause of blindness, in the United States.
Methods: Retrospective chart review of the National Trauma Data Bank (2008-2014) was performed. All patients with ocular trauma were identified using ICD-9CM codes. The collected data were statistically analyzed with student's t-test, Chi-squared test, and logistic regression analysis performed using the SPSS software. The significance was set at p<0.05.
Results: It was found that 316,485 (5.93%) of the 5,336,575 admitted trauma patients had ocular injuries. Their mean (SD) age was 41.8 (23) years, and most of them were men (69.4%). Race/ethnicity distribution was White 66.1%, Black 15.1%, and Hispanic 12.3%. The common injuries were orbital 39.5% and eye/adnexa contusions 34%. Associated traumatic brain injury was present in 58.2%. The frequent mechanisms were falls 25.5%, motor vehicle accident-occupant 21.8%, and struck by/against 17.6%. Patients <21 years of age had higher odds of cut/pierce injuries (OR=3.29, 95%CI=3.07-3.51) than the other age groups, those aged 21-64 years had higher odds of motor vehicle accident-cyclist (OR=4.95, 95%CI=4.71-5.19), and those >65 years had higher odds of falls (OR=16.75, 95%CI=16.39-17.12); p<0.001. The Blacks had a greater likelihood of firearm injuries (OR=3.24, 95%CI=3.10-3.39) than the other racial/ethnic groups, the Hispanics experienced more of cut/pierce injuries (OR=2.01, 95%CI=1.85-2.18), and the Whites experienced more of falls (OR=2.3, 95%CI=2.3-2.4); p<0.001. The Blacks (OR=3.41, 95%CI=3.34-3.48) and Hispanics (OR=1.75, 95%CI=1.71-1.79) mostly suffered assaults, while the Whites suffered unintentional injuries (OR=2.78 95%CI=2.74-2.84); p<0.001. Optic nerve/visual pathway injuries had the greatest association with very severe injury severity scores (OR=3.27, 95%CI=3.05-3.49) and severe Glasgow Coma Scores (OR=3.30, 95%CI=3.08-3.54); p<0.001. The mortality rate was 3.9%.
Conclusions: Male preponderance and falls, motor vehicle accident-occupant, and struck by/against mechanisms agree with the previous reports. The identified demographic patterns underscore the need to develop group-specific preventive measures.
Keywords: Eye injuries; Blindness/prevention & control; United Sates/epidemiology
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Most ocular injuries occurred in the 21-64-year-old age group and men outnumbered women in all groups, except for those aged >80 years.
Frequent mechanisms were falls, MVT-occupant and stuck by or against injuries. MVT= motor vehicle traffic; SBA= struck by or against.
Common of ocular injuries were orbital injuries, contusions of the eye or adnexa, and open wound ocular adnexa.
(A) Falls were the most common mechanism and most likely to occur in the oldest age group, while MVT-cyclist and struck by or against most likely to occur in the 21-64-year-old age group and cut/pierce in the youngest group, when compared to the other groups. (B) Falls were the most likely to occur in white patients, firearms in black patients, and cut/ pierce injuries in Hispanic patients.
(A) Cut/pierce injuries were most associated with mild injury severity and firearms, the most severe injury severity. (B) Similarly, cut/pierce injuries were most associated with the mild levels of TBI and firearms, the most severe level of TBI. ISS= injury severity score; GCS= Glasgow coma score; TBI= traumatic brain injury.