A Comparison of Unintentional Pediatric Ocular Trauma and Injuries Secondary to Assault – Analysis of the National Trauma Data Bank
Ryan A. Gise, MD; Afshin Parsikia, MD, MPH; Joyce M. Mbekeani, MD, FRCS, FRCOphth
Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/Albert Einstein College of Medicine and Department of Surgery (Trauma & Ophthalmology), Jacobi Medical Center
Bronx, New York
Introduction: Ocular trauma is a major cause of morbidity and blindness in the pediatric population. We sought to determine differences in epidemiologic patterns of intentional and unintentional pediatric ocular injury in the US.
Methods: A retrospective review of the National Trauma Data Bank (2008-2014) was performed and patients <21years old, admitted with major trauma and ocular injuries, were identified using ICD-9 codes. The data was analyzed with students’ t and chi-squared tests and odds ratio calculations with SPSS software. Statistical significance was set at p<0.05.
Results: 58,765 pediatric patients were admitted with ocular injuries. The mean (SD; median) age was 11.9(6.9; 14) years. Unintentional injuries (76.3%) were mostly associated with falls (OR=13.4; CI=11-16.3), and open wound of ocular adnexa in 0-3year ages (OR=30.45; CI=23.66-39.19) and intentional or assault (16.3%), with firearms (OR=9.15; CI=8.32-10.06) and eye and adnexa contusions in the 0-3year group (OR=5.8; CI=5.27-6.39); p<0.001). Self-inflicted trauma (0.7%), also was mostly associated with firearms (OR=44.66; CI=36.69-54.37). Open globe and visual pathway injuries were mostly the result of self-inflicted trauma in the 19-21year group (OR=2.74; CI=1.86-4.05) and the 12-18year group (OR=8.37; CI=5.61-12-39), respectively; p<0.001. Orbital fractures resulted mostly from unintentional trauma in the 0-3year group (OR=11.6; CI=8.24-16.32); p<0.001. The majority of pediatric ocular trauma patients (68.7%) were male.
Discussion: Sight-threatening injuries were associated with both intentional and unintentional trauma in the youngest age group and mostly from assault and self-inflicted trauma in the older groups.
Conclusion: Patterns emerged of associations between age groups, different mechanisms and intention of trauma with types of ocular injuries.
References: Barmparas G, Dhillon NK, Smith EJT, Tatum JM, Chung R, Melo N, Ley EJ, Marugulies DR. Assault in Children Admitted to Trauma Centers: Injury Patterns and Outcomes from a 5 Year Review of the National Trauma Data Bank. International Journal of Surgery 2017; 43:137-144
Garcia TA, McGetrick BS, Janik JS, Spectrum of Ocular Injuries in Children with Major Trauma. J Trauma 2005; 59:169-174.
Davies FC, Coats TJ, Fisher R, Lawrence, Lecky FE. A Profile of Suspected Child Abuse as a Subgroup of Major Trauma Patients. Emerg Med J 2015; 32(12): 921-925