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Spectrum of ocular injuries in children with major trauma

Tracey A Garcia1, Betty A McGetrick, Joseph S Janik

  • 1Department of Pediatric Surgery, The Children's Hospital, University of Colorado Health Sciences Center Denver, Colorado, USA.

The Journal of Trauma
|August 13, 2005
PubMed

Insights

Pediatric major trauma patients with severe injuries (Injury Severity Score > 15) have a higher likelihood of ocular and basilar skull fractures. Prompt ophthalmologic evaluation is crucial for these children to detect visual system damage.

Area of Science:

  • Ophthalmology
  • Pediatric Trauma Surgery
  • Emergency Medicine

Background:

  • Limited data exists on the spectrum of pediatric ocular injuries following major trauma.
  • This study aimed to characterize the types and incidence of ocular injuries in children experiencing significant trauma.

Purpose of the Study:

  • To determine the frequency and nature of ocular and adnexal injuries in a large cohort of pediatric trauma patients.
  • To identify specific injury patterns associated with major trauma (Injury Severity Score > 15) in children.

Main Methods:

  • Analysis of 7,497 children with ocular/adnexal injuries from the National Pediatric Trauma Registry (NPTR) database (96,879 total children).
  • Stratification by Injury Severity Score (ISS), age, sex, injury type, restraint use, vision-threatening injury, and basilar skull fracture.
  • Comparison of injury patterns between children with ISS ≤ 15 and ISS > 15.

Main Results:

  • Approximately 8% of pediatric trauma patients in the NPTR sustained ocular injuries.
  • In children with ISS > 15, orbital wall fractures (59%) and contusions (18%) were most common.
  • Children with ISS > 15 showed doubled rates of orbital wall, optic nerve, and cranial nerve injuries, and tripled rates of basilar skull fractures compared to those with ISS ≤ 15.
  • Penetrating globe injuries were less frequent in the severe trauma group (ISS > 15).
  • Over 70% of severe ocular injuries occurred in vehicle accidents, with over 75% of unrestrained children sustaining these injuries.

Conclusions:

  • Children with major trauma (ISS > 15) and ocular injuries are more prone to basilar skull fractures, orbital wall fractures, and contusions.
  • Early ophthalmologic assessment is recommended for pediatric patients with major trauma and ocular injuries to ensure timely diagnosis and management of visual system damage.
Abstract

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