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Pediatric Ocular Trauma: Not Just a Pediatric Trauma Center Problem
Zoe Flyer1,2, John Schomberg3, Andreina Giron1
1Division of Pediatric Surgery, Children's Hospital of Orange County, Orange.
Insights
Pediatric ocular trauma patients are treated similarly in pediatric trauma centers (PTC) and other trauma centers. Younger and Hispanic children were more likely treated at PTCs, with more abuse reports noted in non-PTCs.
Area of Science:
- Ophthalmology
- Trauma Surgery
- Pediatric Medicine
Background:
- Pediatric ocular trauma is a leading cause of monocular blindness.
- Treatment of pediatric eye injuries can vary by facility type.
- This study compares treatment patterns in verified pediatric trauma centers (PTC) versus other trauma centers (non-PTC).
Purpose of the Study:
- To investigate factors influencing the choice of treating facility for pediatric ocular trauma.
- To compare treatment characteristics and outcomes between PTCs and non-PTCs.
- To identify potential disparities in care for pediatric eye injuries.
Main Methods:
- Retrospective cross-sectional study using the National Trauma Data Bank 2019.
- Analysis of pediatric patients (ages 1-18) with ICD-10 ocular trauma diagnoses.
- Logistic regression models assessed associations between treatment facility, injury type, and transfer pathways, adjusting for confounders.
Main Results:
- No significant difference in injury severity (ISS >15) or ocular injury mechanisms between PTCs and non-PTCs.
- Younger children (median age 10 vs 13) and more Hispanic children were treated at PTCs.
- More child abuse reports were identified in non-PTCs (67.6%) compared to PTCs (32.4%).
- Hispanic ethnicity was inversely associated with direct emergency department to operating room transfer.
Conclusions:
- Pediatric ocular traumas are treated at PTCs and non-PTCs with similar severity.
- Younger and Hispanic children are more frequently treated at PTCs.
- Further research is needed to evaluate outcomes and optimize treatment pathways for pediatric ocular trauma.
Background:
Pediatric ocular trauma is the leading cause of monocular blindness and comprises 7% of injuries. Prompt treatment is mandatory but may vary by facility type. This study investigates factors influencing treating facility, comparing level 1 and level 2 verified pediatric trauma centers (PTC) with other trauma centers (non-PTC).
Methods:
The National Trauma Data Bank 2019 was examined for ages 1 to 18 years with ICD10 ocular trauma diagnoses. Descriptive statistics compared patients of PTCs versus non-PTCs. Logistic regression was used to examine the association between treatment at PTC and type of ocular injury, adjusting for age, race, ethnicity, sex, socioeconomic status, injury severity score (ISS), and suspicion of child abuse. A second logistic regression model evaluated the association between direct transfer from emergency department (ED) to operating room (OR) and injury type, and adjusted for confounders. End points included surgical intervention and discharge disposition.
Results:
Of 645 patients with ocular trauma, 67.6% were male, 14% were Hispanic. Median age was 10 years at PTC versus 13 years non-PTC ( P =0.001). Two hundred eighty-two (44%) were treated in PTC. There was no difference in proportion with ISS >15 or mechanism of ocular injury. One hundred forty-six patients were taken directly to OR from ED, with no difference between PTC and non-PTC. The most common diagnoses for patients taken directly to OR were eye or adnexa contusion and laceration, globe or adnexal open wound, and orbital wall fractures. There was no association between type of injury and treatment at PTC versus non-PTC. 71 abuse reports were noted, of which 23 (32.4%) were treated in PTCs, compared with 48 (67.6%) treated at non-PTCs ( P =0.036). Logistic regression examination of direct to OR admission revealed only Hispanic ethnicity was significantly associated ( P =0.03).
Conclusions:
Pediatric ocular traumas are treated at both PTCs and non-PTCs at a similar rate and level of severity. Younger children and more Hispanic children tended to be treated at PTCs. More abuse reports were noted in non-PTCs. Hispanic ethnicity was noted to be inversely associated with direct transfer to OR from ED. This study should form the background from which evaluation of outcomes can begin, to clarify the optimal treatment pathways for pediatric ocular trauma, and if there are disparities in outcomes.
Type Of Study:
Retrospective cross-sectional study.
