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Ari Brandsdorfer, Ryan Gise, David Poulsen, Afshin Parsikia, Joyce Mbekeani; Evaluation of Factors Effecting Disposition of Firearms-related Ocular Trauma: Analysis of National Patterns. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2305. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate factors influencing disposition of patients following admissions for firearms-related ocular trauma.
We identified patients admitted with firearms-related ocular injuries using ICD-9 diagnostic codes and E-codes for mechanism from the National Trauma Data Bank (2008-2014). Tabulated data was analyzed using t-test, chi-squared and regression analysis with SPSS software. Significance was set at p<0.05.
8,715 (3.7%) of 235,254 firearms injuries involved the eye. The mean age was 33.8yrs (median 29; IQR=21-44). Males were 85.7%, Whites 46.6% and Blacks 35%. Mean (SD) length of hospital stay was 9.8 days (14.6) and injury severity score (ISS) was “severe” at 18 (13). Assault comprised 56.8% of cases while 30.1% of injuries were self-inflicted. Common payments were government (31.5%), self-pay (29.4%) and commercial plans (22.8%). Whites had greater odds of Medicare coverage (OR=4.9; CI=4-6) and Blacks, self-pay (OR=1.7; CI=1.5-1.9). Majority of dispositions were home (48.8%), death (16.2%) and rehabilitation (9.4%). Blacks were more likely to be discharged to home (OR=2.3; CI=2-2.6) compared to Whites (OR=0.36; CI=0.32-0.41) p<0.001. Self-paying patients had greater odds of being discharged home (OR=2.4; CI=2.0-2.7) p<0.001. Medicare patients had greater odds of being discharged to higher levels of care (OR=3.9; CI=3.1-4.8) p<0.001. Younger patients (age 0-10) had higher odds of being discharged home (OR=1.9; CI=1.2-2.8) p=0.04 while older patients (age>80) had higher odds of being transferred to another facility, rehabilitation or hospice (OR=10; CI=4-23) p<0.001. Patients with lower ISS (1-8, minor) had higher odds of discharge home (OR=5.8; CI=4.9-7) while higher ISS (>24, severe) had higher odds of discharge elsewhere (OR=4.2; CI=3.7-4.7). There was no statistically significant difference between discharge location and gender. Multivariate regression analysis showed Medicare (OR=2.85; CI=2.2-3.7), White race (OR=2.2; CI=1.8-2.7) and Commercial Insurance (OR=1.2; CI=1-1.4) p<0.001 had the greatest odds of getting advanced post-discharge care,
We identified variance in disposition of firearms-related ocular injuries. Patients who were older, insured, white, and had higher ISS were more likely to be transferred for skilled management while patients who were black, self-paying, younger or had a low ISS were more likely to be discharged home.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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