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RS Baker, D Pan, R Casey; Risk Factors for Enucleation after Hospitalized Ruptured Globe Injury . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3060.
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Purpose: The aims of this study are (1) to generate age-adjusted rates for ruptured globe associated hospitalizations in California from 1990 through 1999, and to document the temporal trends with respect to hospitalization, demography, diagnoses, payer status and utilization outcomes; (2) to identify factors predictive of enucleation after initial ocular trauma associated hospital admission. Methods: Data were derived from the California Hospital Discharge Database representing all admissions to non-federal, acute care hospitals in California between January 1990 and December 1999. All admissions manifesting specific diagnosis code (871.0-871.9) were identified as ruptured globe. Unique patient identifiers were used to create a longitudinal data file through the linkage of all admissions subsequent to the index admission. Statewide population estimates were obtained from 1990 census data and the Demographic Research Unit of the California Department of Finance. Results: A total of 10,765 admissions were found over the 10 year period. There was a dramatic decline in ruptured globe hospital admissions, from 1,529 in 1990 to 790 in 1999. Enucleations also declined accordingly, from 106 in 1990 to 64 in 1999. Age-adjusted admission rates by race were 4.16, 9.98, 5.89 and 2.31 per 100,000 in 1990 for Non-Hispanic White, African American, Hispanic and Asian/other respectively. In 1999, age-adjusted admission rates were 1.38, 4.19, 3.12 and 0.83 per 100,000 for the same race/ethnicity categories. Age-adjusted admission rates by gender were 7.94 and 1.63 per 100,000 for male and female respectively in 1990 versus 3.21 and 0.85 per 100,000 in 1999. Univariate analysis for enucleation operation after initial ruptured globe admission identified age, African American, rupture of eye, avulsion of eye, drug abuse, endophthalmitis as significant risk factors for enucleation. A diagnosis of laceration of eye or penetration of eyeball with magnetic/non-magnetic foreign body or retinal detachment or cataract was associated with decreased risk for enucleation. Multivariate analysis obtained similar results. Conclusion: The California Hospital Discharge Database is a useful instrument for studying medical trends. Age-adjusted rates for ruptured globe associated hospital admissions declined by nearly 50% in California from 1990 to 1999. African American race, drug abuse and endophthalmitis are factors which predict and increased likelihood of enucleation in patients admitted for ruptured globe injuries.
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