Abstract
Purpose :
Ruptured globes are ophthalmic emergencies that require immediate intervention to prevent vision loss. Current ocular trauma classification systems enable accurate comparisons of clinical data across studies and assist in prognosticating visual outcome. However, these systems do not incorporate indices of injury severity that may impact overall morbidity and survival. We sought to compare epidemiologic characteristics of simultaneous ruptured globe and orbital injuries (RGO) with isolated ruptured globe injuries (RG) focusing on severity.
Methods :
A retrospective review of the National Trauma Data Bank (2008-2014) identified patients admitted with ruptured globe with and without orbital injuries using ICD9CM and E-codes. Students' t and X2 tests and odds ratios (OR) were calculated with STATA 15.1 software. Significance was set at p<0.05.
Results :
Of 28,364 patients admitted with ruptured globe injuries, 23,873 (86.2%) were isolated and 4,491 (15.8%) were associated with orbital injuries. Mean (SD) age of RGO was 43.9(20.7) yrs and RG was 38.1(23.2) yrs; p<0.001. Most patients were male (RG, 74.8% and RGO, 74.7%). Common mechanisms for RG were struck by/against, SBA (23.6%), and fall (17.8%); for RGO, SBA (24.7%) and firearms (17.6%). Most injuries were unintentional (RG, 70.0%, RGO, 56.9%), but RGO had higher rates of assault (30.7%, RG 17.2%) and suicide (6.2%, RG, 2.9%). RG patients had greatest odds of low injury severity score, ISS (OR=4.71, 95%CI=4.57-4.86) and mild traumatic brain injury, TBI (OR=1.76, 95%CI=1.68-1.84), while RGO patients had greatest odds of very severe ISS (OR=1.47, 95%CI=1.35-1.61; p<0.001) and severe TBI (OR=1.48, 95%CI=1.35-1.62; p<0.001). RG injuries were most associated with retinal edema (OR=1.62, 95%CI=1.44-1.59), and RGO, with optic nerve/visual pathway injuries (OR=3.88, 95%CI=2.74-3.95); p<0.001. RGO patients also had higher odds of hospital stays >6days (OR=1.46, 95%CI-1.36-1.56) and mortality (OR=1.20, 95%CI=1.02-1.41); p<0.001, than RG patients.
Conclusions :
Patients with RGO were in a younger demographic, more likely to have higher ISS and TBI, have longer hospital stays, and have increased rates of mortality than patients with RG. These differences have implications for comprehensive management, variable rehabilitation, visual recovery, and global morbidity.
This is a 2020 ARVO Annual Meeting abstract.