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Katrina Chin Loy, Augustine Obirieze; Disparities in the Treatment of Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6035.
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© ARVO (1962-2015); The Authors (2016-present)
Ocular trauma is an important and potentially preventable cause of vision loss worldwide. Traumatic open globe injury is an ophthalmic emergency involving compromised integrity of the cornea or sclera. In order to ensure the best ocular prognosis and potential for vision preservation or restoration, the standard of care for open globe injuries requires prompt evaluation with initiation of antibiotics and primary surgical wound closure emergently, ideally within 24 hours or injury. Delay in treatment by even a few hours may result in increased risk of poor outcomes. The goal of our study is to further characterize demographics of trauma patients that present with open globe injuries and elucidate potential disparities in receiving the standard of care.
Between 2007 and 2010, 773 trauma centers across the United States submitted information to the National Trauma Databank (NTDB). From that dataset, patients included in the study were those >18 years of age who presented with a diagnosis of open globe injury at a Level I or II Trauma Center. Patients were excluded if they were dead on arrival or died in the emergency room. Patients without data reported for race or gender were also excluded. The primary variable of interest studied was race/ethnicity with co-variates including age, gender, mechanism of injury, hospital type, insurance type. Primary outcome examined was time to operating room. All results were analyzed with STATA/MP version 12.0.
A total of 10,928 cases in the NTDB met the inclusion criteria. Fifty-nine percent of the patients were White, 22% Black, and 4% Hispanic. The majority of patients were between ages 25 and 44. Compared to Whites, who presented at a mean age of 49-years-old, Blacks presented on average 8 years younger (p<0.0001) and Hispanics 12 years younger (p<0.0001). Of those patients who presented with open globe injuries, 8,199 patients underwent ocular surgery. Eighty-four percent of surgeries were performed within 24 hours of presentation. The adjusted mean time to surgery was 15 hours for White patients, 20 hours for Black patients and 13 hours for Hispanic patients (p<0.05).
Based on this database review, there do exist statistically significant differences between Whites, Blacks and Hispanics in terms of age of presentation for open globe injuries and mean time to surgical evaluation and repair of such injuries.
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