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Andrea Honda, Paul Latkany, Monica Lorenzo, Emily Su; Utilizing HIWA, a Scoring System of Pediatric Ocular Trauma Retrospective Reports, Analyzing Existing Literature and Informing Future Standards. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4440.
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Less than 0.3% of surgical interventions in general pediatric surgery are supported by randomized controlled trials. Scoring systems have been published to rank the significance of retrospective pediatric surgical trials outside of the ophthalmic literature. Up to 43% of open-globe injuries occur in individuals less than 18 years old. We investigate standards for reporting retrospective studies on pediatric ocular trauma and determine the inter-rater agreement of a new retrospective pediatric ocular trauma literature scoring system.
We identified pediatric trauma articles using Pubmed from January 1, 2000 through August 1, 2011 in four comprehensive ophthalmology journals. We then selected all of the articles that had follow-up with exclusively a pediatric patient population. We created a novel scoring system, HIWA, for assessing the quality of retrospective clinical studies in pediatric eye trauma. We built on generic retrospective pediatric surgical scoring system by dividing the scoring into three categories 1) potential clinical relevance 2) quality of study methodology 3) quality of discussion and stated conclusion. A global qualifying score was derived by combining the score from each subscale. Three independent reviewers were utilized to determine the inter-rater agreement of HIWA.
We identified 11 articles in pediatrics with 3290 patients. Six articles exclusively followed patients with pediatric eye trauma. Four articles reported a follow-up at 6 months, only three used a scoring system of any type. In the six articles, the mean age was 8.3 years old with a range of 1 day old to 18 years old. 164 (40.4%) were females. 359 were unilateral injuries and 29 were bilateral. The range of follow-up was from 3 days to 4,320 days and a mean of 244 days. The HIWA inter-rater reliability was excellent with > 95% concordance for 20 items. The HIWA global quality rating is good. The ranking of papers by individual reviewers was highly predictive of overall ranking by mean quality scores (n=18 rank pairs, r=0.90, p < 0.05).
There is woefully non-standardized reporting in the pediatric ocular trauma articles that did not facilitate data aggregation and meta-analysis. HIWA will help standardize reporting of pediatric ocular trauma and categorize existing reports.
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