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Characteristics of pediatric ocular trauma in a pediatric emergency department in Japan
Masakazu Kinoshita1, Takateru Ihara2, Takaaki Mori3
1Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561, Japan.
Insights
Pediatric ocular trauma is common, often involving closed globe injuries managed safely in emergency departments. Few cases require surgery or lead to complications, indicating effective emergency physician care.
Area of Science:
- Ophthalmology
- Pediatric Emergency Medicine
- Trauma Care
Background:
- Pediatric ocular trauma is a significant cause of acquired monocular blindness.
- Limited data exists on the epidemiology and emergency department (ED) management of pediatric ocular trauma.
- Understanding these aspects is crucial for improving patient outcomes.
Purpose of the Study:
- To describe the characteristics of pediatric ocular trauma patients presenting to a Japanese pediatric ED.
- To analyze the management strategies employed for pediatric ocular trauma in the ED.
- To provide insights into the epidemiology and outcomes of pediatric eye injuries.
Main Methods:
- Retrospective, observational study conducted in a Japanese pediatric ED from March 2010 to March 2021.
- Inclusion criteria: Children under 16 diagnosed with ocular trauma, excluding follow-up visits.
- Data extracted from electronic medical records included demographics, injury details, examinations, diagnoses, referrals, and outcomes.
Main Results:
- 469 patients included: 68% male, median age 7.3 years.
- Most common injury mechanism: being struck in the eye (34%), often at home (26%).
- Predominantly closed globe injuries (99.6%); 8% required urgent ophthalmological referral, 3% needed emergency surgery, and 2% experienced complications.
Conclusions:
- Pediatric ocular trauma in this cohort was primarily closed globe injuries.
- Emergency department management by pediatric emergency physicians appears safe and effective.
- A low incidence of severe outcomes suggests successful initial care in the ED setting.
Introduction:
Pediatric ocular trauma is a common complaint in pediatric emergency departments (ED) and is a major cause of acquired monocular blindness. However, data on its epidemiology and management in the ED are lacking. The objective of this study was to describe the characteristics and management of pediatric ocular trauma patients who visited a Japanese pediatric emergency department (ED).
Methods:
The present, retrospective, observational study was conducted in a pediatric ED in Japan between March 2010 and March 2021. Children younger than 16 years who visited our pediatric ED and received the diagnosis of ocular trauma were included. ED visits for follow-up examinations for the same complaint were excluded. The patients' sex, age, arrival time, mechanism of injury, signs and symptoms, examinations, diagnosis, history of urgent ophthalmological consultation, outcomes, and ophthalmological complications were extracted from electronic medical records.
Results:
In total, 469 patients were included; of these, 318 (68%) were male, and the median age was 7.3 years. The incident leading to trauma occurred most frequently at home (26%) and most often involved being struck in the eye (34%). In 20% of the cases, the eye was struck by some body part. Tests performed in the ED included visual acuity testing (44%), fluorescein staining (27%), and computed tomography (19%). Thirty-seven (8%) patients underwent a procedure in the ED. Most patients had a closed globe injury (CGI), with only two (0.4%) having an open globe injury (OGI). Eighty-five (18%) patients required an urgent ophthalmological referral, and 12 (3%) required emergency surgery. Ophthalmological complications occurred in only seven patients (2%).
Conclusion:
Most cases of pediatric ocular trauma seen in the pediatric ED were CGI, with only a few cases leading to emergency surgery or ophthalmological complications. Pediatric ocular trauma can be safely managed by pediatric emergency physicians.
