This study examines the incidence, characteristics and economic burden of orbital floor fractures in the United States.
Study design
This is a retrospective, longitudinal study of the Nationwide Emergency Department Sample (NEDS), a representative sample of all hospital-based emergency departments (EDs) in the United States. ED visits with a primary diagnosis of orbital floor fracture from 2006 to 2017 were identified. Investigators estimated the trends in annual incidence and inflation-adjusted ED charges as well as variables associated with inpatient admission.
Outcomes
Collectively, 350,379 ED visits with the primary diagnosis of orbital floor fracture were identified. The incidence increased by 47% over the study period, from 7.7 to 11.3 per 100,000 population.
About two-thirds of fractures occurred in men aged 21 to 44 years from low-income households, with the most common cause being assault (43%). The second most common cause was falls (26%), most frequently seen in patients older than 65 years, an incidence that more than doubled over the study period (1.6 to 3.5 per 100,000 population). Inpatient admission was more likely among patients older than 65 years and also insured patients. The total inflation-adjusted ED charges over the study period was greater than $2 billion, increasing from $5,881 to $8,728 per visit.
Limitations
As this study is dependent on the correct entry of the ICD codes and included patients with only the primary diagnosis of orbital floor fracture, many patients with a secondary relevant diagnosis may have been excluded. In addition, patient information may have been duplicated due to the use of encounter-level data rather than patient-level data.
Clinical significance
This study demonstrates the significant economic burden of orbital fractures on the U.S. healthcare system as well as the vulnerable populations (e.g., low-income, young men secondary to assault and older individuals secondary to falls). These findings show that orbital floor fractures are becoming increasingly common and costly. Preventive strategies to help decrease these injuries should be considered.