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Timothy Truong, Sabine S. Khan, Afshin Parsikia, JOYCE MBEKEANI; Patterns of Ocular Trauma Secondary to Violence Against Children. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2513.
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© ARVO (1962-2015); The Authors (2016-present)
Violence against children can result in significant morbidity that includes visual disability and blindness and has an estimated annual rate of 9.4 per 1000 in the US. We sought to determine patterns of assault-related pediatric ocular trauma.
A retrospective review of the National Trauma Data Bank (2008-2014) identified patients <21yrs old, admitted with assault-related ocular injuries using ICD-9CM and E-codes. Students' t and X2 tests and odds ratios (OR) were calculated with SPSS software. Significance was set at p<0.05.
9,579 (16.3%) of 58,765 pediatric patients admitted with ocular injuries were a result of assault. Common ages were 12-18yrs (36.6%), 19-21yrs (30.4%) and 0-3yrs (30%). Mean(SD) was 12.3(8.1)yrs. 77.5% were male. Racial distribution was 41.7% Whites, 31.4% Blacks and 20.0% other; Hispanic ethnicity was 20.4%. The Southern region (36.4%) reported most cases. Common mechanisms were struck by/against (SBA) (47.8%) and firearms injuries (FAI) (13%). Locations were home (38.2%) and street (16.6%). Frequent injuries were contusion of eye/adnexa (46.3%), orbital injury (33.1%), open wound of ocular adnexa (14.4%) and ruptured globe (10.8%). Mean (SD) Glasgow coma score (GCS) and injury severity score (ISS) were moderate at 12.7(4.2) and 12.5(10.2), respectively. However assault was significantly associated with very severe injuries (ISS>24) and severe TBI (GCS≤8) (p<0.001). 63.1% had associated traumatic brain injury (TBI) and mortality rate was 6.6%. Patients 0-3yrs had 2.83 odds of assault (CI=2.27-2.51; p<0.001), followed by the 19-21yr group (OR=1.93, CI=1.83-2.02; p<0.001). The youngest had highest odds of contusions of eye/adnexa (OR=5.81, CI=5.27-6.39) and visual pathway injuries (OR=3.99, CI=3.02-5.27); p<0.001 and the oldest, orbital injuries (OR=1.64, CI=1.51-1.79; p=0.001). Blacks (OR=3.28, CI=2.90-3.70; p<0.001) and Hispanics (OR=1.16, CI=1.00-1.33; p=0.05) had higher odds of FAI than other mechanisms. Whites did not exhibit a propensity for one mechanism. FAI was associated with ISS>24 (OR=2.06, CI=1.78-2.38) and GCS<8 (OR=1.82, CI=1.57-2.10); p<0.001.
Assault-related eye injuries disproportionately affected males, Blacks, Hispanics, and those in the South. The age distribution was bimodal but the most severe injuries were seen in younger patients. The majority survived their injuries, with potential for long-term disability.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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