Clinical Decision Rule to Identify Orbital Wall Fracture Among Children: Retrospective Derivation and Validation...

Area of Science:

• Pediatric Emergency Medicine
• Ophthalmology
• Radiology

Background:

• Head and face injuries are common causes of pediatric emergency department visits.
• Currently, no established clinical decision rule exists for facial computed tomography (CT) scans in children, unlike pediatric head CT rules.
• Identifying orbital wall fractures in children with periorbital trauma requires a reliable diagnostic tool.

Purpose of the Study:

• To develop and validate a clinical decision rule (CDR) for the identification of orbital wall fractures in pediatric patients presenting with periorbital trauma.
• To establish a practical tool for emergency department use to guide the need for orbital CT scans.

Main Methods:

• A retrospective derivation and validation study was conducted involving children under 18 years old who underwent orbital CT after periorbital trauma.
• Thirteen clinical signs and symptoms were analyzed as potential predictors from 16 candidate variables.
• A 4-variable predictive model was developed and validated using 3-fold cross-validation and receiver operating characteristic (ROC) curve analysis.

Main Results:

• The optimal predictive model included four variables: orbital rim tenderness, periorbural ecchymosis, painful extraocular movement, and nausea/vomiting.
• The area under the ROC curve (AUROC) for fracture prediction was 0.793 in the derivation cohort and 0.809 in the validation cohort.
• High sensitivity (96.4%-97.8%) and negative predictive values (93.4%-98.1%) were achieved. A score of 1 or higher indicated an increased fracture risk.

Conclusions:

• A 4-variable predictive model demonstrates utility in identifying clinically significant orbital wall fractures in children.
• This clinical decision rule can aid emergency physicians in managing pediatric periorbital trauma and determining the necessity of orbital CT scans.