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Ryan Gise, David Poulsen, Yssra Soliman, Afshin Parsikia, JOYCE MBEKEANI; PATTERNS OF VISUAL PATHWAY INJURIES IN NATIONAL MAJOR TRAUMA ADMISSIONS. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5943.
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© ARVO (1962-2015); The Authors (2016-present)
Traumatic optic neuropathy and other visual pathway injuries (VPI) result from direct and indirect head trauma and are associated with greater morbidity and mortality. We sought to evaluate the epidemiologic patterns of these neuroophthalmic injuries in the US.
A retrospective review of the National Trauma Data Bank (2008-2014) was conducted and patients with VPI were identified using ICD-9 codes. Statistical analysis was performed with SPSS software. Variables were correlated using student t-test, Chi-squared test and odds ratios. Significance was set at p<0.05.
4045 (1.3%) from a total of 316,485 patients, admitted with ocular trauma, were diagnosed with VPI. The mean age was 36.2yrs (SD=20.7) with a median of 33yrs (IQR=21-51). Males were 75% and younger (mean=35.8) than females (mean=37.4); p<0.001. Whites made up 62.8%, Blacks 18.3% and “other” 18.9%. Geographic regions reporting most traumas were the South (35%) and Midwest (24%). Traumatic brain injury (TBI) was reported in 78.5% of cases. The pre-chiasmal optic nerve was affected in 87.4%. Other cranial nerves frequently affected with VPI were the oculomotor (46%), facial (36.5%) and abducent (25.5%) nerves. Common associated ocular injuries were orbital fractures (34.8%) and eye/adnexa contusions (20.6%). Mean injury severity score (ISS) was “severe,” 19.8 (SD=12.5) and mean hospital stay was 11 days (SD=14.7). Mortality occurred in 9.2%. Common mechanisms were motor vehicle trauma-occupant, MVTO (18.6%), firearms (17.1%), struck by against, SBA (14.1%) and falls (14.1%). Common locations were the street (39.2%) and home (28.8%). Motorcycle accidents (MCA) had the highest odds of having associated TBI (OR=3.2; CI 2-5). Whites had greater odds of having MCA (OR=2.9; CI 2.1-4.1) and self-inflicted injuries (OR=2.8 CI 2.1-3.7); p<0.001 and Blacks, firearms (OR=3.2; CI 2.7-3.8) and assaults (OR=5.4; CI 4.5-6.4); p<0.001. The <21yrs group had greater odds of MVT-occupant (OR=1.3; CI 1.1-1.5; p=0.01), the 21-64yr group, MCA (OR=5.4; CI 3.5-8.3; p<0.001) and the >65yrs group, falls (OR=11.6; CI 9.2-14.6; p<0.001).
Visual pathway injuries were most common in young males and due mostly to MVTO and firearms. Traumatic optic neuropathy was the most common visual pathway injury and the majority of cases had associated TBI. Identified age, gender and racial differences could be useful for implementing trauma prevention strategies.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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