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J. Knippers, M. A. Slabaugh, J. Brown, J. Lee; Comparision of Ocular Trauma Score and Classification and Regression Tree Analysis Model in Tertiary Care Center. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5324.
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To compare the Ocular Trauma Score (OTS) and a recently proposed classification and regression tree (CART) analysis by Schmidt et al. in a tertiary care facility.
Retrospective chart review of 131 consecutive open globe patients presenting to Harborview Medical Center (level 1 trauma center for 5 state region) from October 2005 to December 2006. These models predict visual outcome after open globe injury. The OTS uses variables including initial vision, afferent pupil defect (APD), rupture, endophthalmitis, perforating injury, and retinal detachment to stratify patients. A numerical score is then given and categorized into 5 groups to predict visual acuity. The CART model uses similar variables including visual acuity, APD, mechanism injury, age, presence of lid laceration and location of globe injury to construct a prognostic tree. The final best corrected visual acuity was then compared to the predicted acuity in each model. Statistical analysis was done with the fisher’s exact test.
62 eyes of 60 patients met the inclusion criteria for calculation in both the OTS and CART model, including all variables recorded at initial exam and at least 6 months of follow up. Mean age was 41 (4 to 88 years), 78% male, 22% female, mean follow up 11.6 months (6- to 21 months) CART model had a sensitivity of 94.2, specificity 37 to predict vision versus no vision outcome while the OTS yielded a sensitivity of 85.7, specificity of 77.7. The CART model predicting vision greater 20/400 yielded a sensitivity 84.6 and specificity of 72.2, while the OTS model predicting an outcome of 20/200 or better yielded a sensitivity of 79.1, specificity of 89.4. There was no statistically significant difference when comparing sensitivity p=0.86 or specificity=0.63 between the two models predicting vision or no vision.
Both the OTS and CART models are accurate predictors of visual acuity outcomes after open globe injury. The use of both of these models in initial evaluation and counseling of patients after open globe injury will be valuable.
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