Pediatric traumatic brain injury and ocular injury

Ocular injuries among patients with major trauma in England and Wales from 2004 to 2021

BACKGROUND

Ocular trauma is a significant cause of blindness and is often missed in polytrauma. No contemporary studies report eye injuries in the setting of severe trauma in the UK. We investigated ocular injury epidemiology and trends among patients suffering major trauma in England and Wales from 2004 to 2021.

METHODS

We conducted a retrospective study utilising the Trauma Audit and Research Network (TARN) registry. Major trauma cases with concomitant eye injuries were included. Major trauma was defined as Injury Severity Score >15. Ocular injuries included globe, cranial nerve II, III, IV, and VI, and tear duct injuries. Orbital fractures and adnexal and lid injuries were not included. Demographics, injury profiles, and outcomes were extracted. We report descriptive statistics and 3-yearly trends.

RESULTS

Of 287 267 major trauma cases, 2368 (0.82%) had ocular injuries: prevalence decreased from 1.87% to 0.66% over the 2004-2021 period (P < 0.0001). Males comprised 72.2% of ocular injury cases, median age was 34.5 years. The proportion of ocular injuries from road traffic collisions fell from 43.1% to 25.3% while fall-related injuries increased and predominated (37.6% in 2019/21). Concomitant head injury occurred in 86.6%. The most common site of ocular injury was the conjunctiva (29.3%). Compared to previous TARN data (1989-2004), retinal injuries were threefold more prevalent (5.9% vs 18.5%), while corneal injuries were less (31.0% vs 6.6%).

CONCLUSIONS

Whilst identifying eye injuries in major trauma is challenging, it appears ocular injury epidemiology in this setting has shifted, though overall prevalence is low. These findings may inform prevention strategies, guideline development and resource allocation.

Characteristics of ocular injuries associated with mortality in patients admitted with major trauma

BACKGROUND

Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries.

METHODS

A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05.

RESULTS

Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity.

CONCLUSIONS

Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.

Ocular Trauma in Children: An Epidemiological Study

OBJECTIVES

This study aimed to determine the epidemiology of eye injuries in children and the influential factors involved.

METHODS

Eighty cases of confirmed ocular trauma were included in this cross-sectional study. Data were obtained via a checklist containing demographic information, site of the insult, the interval between the injury and physician visit, trauma mechanism, and medical history, including previous history of ocular trauma.

RESULTS

Among 80 children with ocular trauma, 72.5% (n = 58) were boys. A marked preponderance (46.2%) of injuries was seen in the age group younger than 6 years. The youngest patient was a 1-year-old, and the oldest was aged 17. Most (76.25%) of the incidents occurred indoors. A total of 67.5% of accidents were induced by sharp objects (knife and glass). Most accidents occurred in spring, whereas the least number of accidents occurred in winter. The corneoscleral laceration was the most common manifestation, followed by the laceration of the iris, uveal prolapse, hyphema, and cataracts. Furthermore, rare cases of retinal detachment, hypopyon, and corneal epithelial defects were seen.

CONCLUSIONS

The highest incidents of ocular trauma occurred in boys, especially those younger than 6 years. The high number of sharp object injuries is also concerning. These findings provide us with evidence that further educational interventions and supervision are required in these groups to minimize the possible devastating injuries before the opportunity even arises.

Epidemiological findings of childhood ocular trauma in a public hospital in Colombia

Background

Eye injury is a serious worldwide public health problem that may cause blindness. In children, blindness has functional impact and psychosocial implications. As indicated in many worldwide studies, identification of risk factors associated with the socio-cultural context may prevent eye injuries. The objetive of the study is to describe the sociodemographic and epidemiological characteristics of pediatric eye injury and its effects on ocular structures in a public hospital from Colombia.

Method

A retrospective cross-sectional study was carried out between January 1, 2015, and December 31, 2017, in a tertiary public hospital of a medium-sized city located in the Northeast of Colombia. Children under 15 years old with trauma to the eyeball or its adnexa were included. The Birmingham Eye Trauma Terminology System (BETTS) was used. Eye burns and Ocular adnexa were also included.

Results

61 cases of eye injuries were recorded, 67.21% (41 cases) of which were males. 57.37% (35 cases) corresponded to closed-globe injuries both contusion and lamellar laceration. Visual acuity fluctuated between 20/20 and 20/40. 14.75% (9 cases) were open-globe injuries while 50% (4 cases) were penetrating trauma. 27.86% of the injuries (17 cases) did not directly compromise the eyeball, 58.82% (10 of these cases) of which corresponded to eyelid wounds, and neither of those had visual acuity information.

Conclusion

The study showed that the majority of eye injuries in children under 15 years old, from a public hospital in the Northeast of Colombia, are closed globe, caused by blows, and occur in males.

Pediatric Eye Emergency Department Visits: Retrospective Review and Evaluation

PURPOSE

To assess the epidemiology of pediatric ocular conditions presenting to an ophthalmic emergency department and analyze the incidence of ocular trauma and other ophthalmic diagnoses.

METHODS

A retrospective review was performed of all patients seen in an urban eye emergency department over a 1-year period. The following variables were examined: visit date, demographics, diagnosis, mechanism of injury, and level of patient care.

RESULTS

Analysis was performed on 1,136 pediatric visits spanning 1 year. Trauma was the most common etiology, seen in 44.4% of patients, followed by infection in 19.3%. The largest volume of pediatric use was in the spring and early summer, with the peak of trauma in the spring. Most admissions of pediatric patients were due to trauma (76.4%), of which the most common diagnoses were ruptured globe (27.3%), eyelid laceration (18.2%), and orbital fracture (10.9%). Sporting activities were the most frequent broad cause of trauma seen in pediatric patients, accounting for 30.9% of all trauma, whereas the highest singular cause of trauma was injury by air guns (9.5%).

CONCLUSIONS

Pediatric ophthalmic emergency department visits in this urban setting are most often due to trauma, with increased use in the spring and early summer. A majority of the more serious conditions leading to admission can be attributed to trauma, which is often preventable. Knowledge of patterns of visits could improve planning of ophthalmology physician coverage. [J Pediatr Ophthalmol Strabismus. 2021;58(2):84-92.].

Injury Biomechanics of a Child’s Head: Problems, Challenges and Possibilities with a New aHEAD Finite Element Model

Traumatic brain injury (TBI) is a major public health problem among children. The predominant causes of TBI in young children are motor vehicle accidents, firearm incidents, falls, and child abuse. The limitation of in vivo studies on the human brain has made the finite element modelling an important tool to study brain injury. Numerical models based on the finite element approach can provide valuable data on biomechanics of brain tissues and help explain many pathological conditions. This work reviews the existing numerical models of a child’s head. However, the existing literature is very limited in reporting proper geometric representation of a small child’s head. Therefore, an advanced 2-year-old child’s head model, named aHEAD 2yo (aHEAD: advanced Head models for safety Enhancement And medical Development), has been developed, which advances the state-of-the-art. The model is one of the first published in the literature, which entirely consists of hexahedral elements for three-dimensional (3D) structures of the head, such as the cerebellum, skull, and cerebrum with detailed geometry of gyri and sulci. It includes cerebrospinal fluid as Smoothed Particle Hydrodynamics (SPH) and a detailed model of pressurized bringing veins. Moreover, the presented review of the literature showed that material models for children are now one of the major limitations. There is also no unambiguous opinion as to the use of separate materials for gray and white matter. Thus, this work examines the impact of various material models for the brain on the biomechanical response of the brain tissues during the mechanical loading described by Hardy et al. The study compares the inhomogeneous models with the separation of gray and white matter against the homogeneous models, i.e., without the gray/white matter separation. The developed model along with its verification aims to establish a further benchmark in finite element head modelling for children and can potentially provide new insights into injury mechanisms.

A comparison of pediatric ocular injuries based on intention in patients admitted with trauma

Purpose

Pediatric ocular trauma is a major source of morbidity and blindness and the number of epidemiological studies is incommensurate with its significance. We sought to determine differences in epidemiologic patterns of pediatric ocular injuries based on intention.

Methods

A retrospective review of the National Trauma Data Bank (2008–2014) was performed and patients < 21 years old, admitted with trauma and ocular injury, were identified using ICD-9CM codes. Demographic data, types of injury and external circumstances including intention were tabulated and analyzed with students’ t and chi-squared tests and logistic regression. Statistical significance was set at p < 0.05.

Results

Fifty-eight thousand seven hundred sixty-five pediatric patients were admitted for trauma and ocular injuries. The mean(SD) age was 11.9(6.9) years. Most patients were male (68.7%) and White (59.1%). Unintentional injuries (76.3%) were mostly associated with falls (OR = 13.4, p < 0.001), assault (16.3%) with firearms (OR = 9.15, p < 0.001) and self-inflicted trauma (0.7%) also with firearms (OR = 44.66, p < 0.001). There was increasing mean(SD) age from unintentional, 12.9(6.6) years and assault 12.3(8.1) years to self-inflicted trauma, 17(3.4) years. The 0-3 year age group had highest odds of open adnexa wounds (OR = 30.45, p < 0.001) from unintentional trauma, and traumatic brain injury (TBI) (OR = 5.77, p < 0.001) and mortality (OR = 8.52, p < 0.001) from assault. The oldest 19-21 year group, had highest odds visual pathway injuries (OR = 8.34, p < 0.001) and TBI (OR = 1.54, p = 0.048) from self-inflicted trauma and mortality (OR = 2.08, p < 0.001) from unintentional trauma.

Conclusion

Sight-threatening injuries were mostly associated with unintentional trauma in the youngest group and self-inflicted trauma in the oldest group. Patterns emerged of associations between demographic groups, mechanisms, types of injury and associated TBI with intention of trauma.

Electronic supplementary material

The online version of this article (10.1186/s12886-018-1024-7) contains supplementary material, which is available to authorized users.